Transcript Intro QALY & need assessment

Cost Effectiveness in Preventing Crime
 Jan
van Busschbach, Djøra Soeteman
 Viersprong Institute for studies on Personality Disorders

• VISPD
Erasmus MC
• Department of Medical Psychology and Psychotherapy
1
Reputation health economics
2
Reputation
 Health
economics….it is all about budgets…
 “We didn’t actually overspend the budget….The
Health Commission allocation simply fell short of
our expenditure”
(Keith Davis)
3
Health economics ≠ budget
 It
is more about what you can do, given a (fixed)
budget…
 Trade-off between effects

Given your budget
4
Do economics help….?
 Te
aim of a car is “transportation”
 Cost effectiveness = Cost / km
Jeep Grand Cherokee 4.7….€
1,143 per km (2006)
Suzuki New Alto 1.1 5-d glx
Cool….. € 0.259
5
Cost effectiveness does not
predict allocation….
 Either
 Cost effectiveness is invalid…
 or discussion about the aim of the interventions
• The definition of the effects….
 The
effects are most often discussed
 Not the budget calculations
 Therefore
guidelines
 To obtain compatibility…
6
Few cost effectiveness studies
 According
to guidelines about a dozen
 Non in The Netherlands
 Welsh
& Farrington, 2000
 A review of the literature revealed only seven [7] published studies
that have presented information on monetary costs and benefits.
 McDougall
et al., 2003
 A systematic review of the literature revealed only nine [9]
published studies that fit the criteria of the review.
 Swaray
et al., 2005
 “10 studies fit the criteria of the review”
7
Build cost benefit studies on the
basis of effect studies….
www.wsipp.wa.gov/pub.asp?docid=98-01-1201
Steve Aos, Robert Barnoski, Roxanne Lieb
8
What they did….
9
16 interventions
 Tax
payer perspective
 5 losses
 11 gains
 Societal
perspective
 3 losses
 13 gains
10
Confirmation by formal Cost
effectiveness studies
The public costs and benefits per participant of the High/Scope
Perry Preschool Study (Schweinhart, 2003).
11
Why seek further…
 Interventions
seem cost effective…
 In terms of monetary cost benefit
 What
is the point of not implementing…?
12
Are we overlooking societal
relevant outcomes….
Jeep Grand Cherokee 4.7….€
1,143 per km (2006)
Suzuki New Alto 1.1 5-d glx
Cool….. € 0.259
13
Are we overlooking societal
relevant outcomes?
 Revenge
(Genoegdoening)
 What is the price of losing societal revenge….
 If overlooked, cost effectiveness of alternatives are too optimistic
 Do
we agree what the effects of prevention should
be?
 If not….how can we determine cost effectiveness?
 The question of economics is not technical…but fundamental
14
Not restricted to crime prevention
in youth
 Prevention
in smoking costs money
 When only valuing cost items…
 As in diabetes etc
 But
the aim of prevention is to increase life
expectation…
 So value the increase of live expectation…
“The aim of health care is not to save money but to save
people from preventable suffering and death. Any potential
savings on health care costs would be icing on the
cake….” (Bonneux et al., 1998)
15
What is the value of life?
16
What is the value of life?
17
Or make life years the effect….
 Cost
per life year gained
 Cost per quality of life adjusted year (QALY)
1980[pdat] AND (QALY or QALYs)
600
Publications
500
400
300
200
100
0
1980
1985
1990
1995
2000
2005
2010
18
Generic outcomes
 If
we want to compare quite different treatment
options…
 Detention
 Family Coaching
 We
can not use treatment specific outcomes
 Numbers of days in jail
 Family cohesion
 Generic
outcomes
 That are relevant for both
 That are relevant for the policy question
19
What are good generic outcomes
in crime prevention?
 Well….
 Asking the question is answering it…
 Crime!
• Cost per crime avoided
• Open for debate
• Quality of crime?
 Treatment
specific outcomes….
 Like family cohesions
 Might be relevant for the treatment
 Are popular in scientists
 But are of limited relevance for policy making….
20
Conclusion
 The
odds are favorable
 Many alternatives are expensive
 Many alternatives are ineffective
 Choose
societal relevant outcomes
 Contains a fundamental discussion about the aim of prevention….
 My favorite: Crime prevention
21