Intro QALY & need assessment
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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…
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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
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What they did….
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16 interventions
Tax
payer perspective
5 losses
11 gains
Societal
perspective
3 losses
13 gains
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Confirmation by formal Cost
effectiveness studies
The public costs and benefits per participant of the High/Scope
Perry Preschool Study (Schweinhart, 2003).
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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
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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)
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What is the value of life?
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What is the value of life?
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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
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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
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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….
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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
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