Transcript Intro QALY & need assessment

Cost Effectiveness
 Jan
J.V. Busschbach, Ph.D.
 Viersprong Institute for studies on Personality Disorders VISPD


• [email protected]
Erasmus MC
Institute for Medical Psychology and Psychotherapy
1
(Health) Economics
 Comparing
different allocations
 In health care: Should we spent our money on

• Wheel chairs
• Screening for cancer
Intervention in youth
• Jail
• Cure
• Prevention
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Assumptions
 Agreement
on the budget
 Agreement
on outcome
 Assumption of scarcity
 What are the intended effects
 Possible
to moves between budgets
3
Economics in policy
 Economics
in policy are often
 Only Better effects for the same (or less) money


• “Doelmatigheid”
Efficiency improvement
Budget impact
4
Car economics
 Should
we spend our money on a
 Suzuki Alto 1.0
 BMW 316
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Car economics
 Cost
effectiveness
 Comparing costs
 Comparing outcome
 Relate
costs to outcome
 Cost per outcome
 Cost per kilometer
6
League Table
Car
€ / Km
Car
€ / Km
Suzuki Alto 1.0
0.24
Hyundai Lantra 1.5
0.47
Daihatsu Cuore 1.0
0.27
Opel Vectra 1.6
0.53
Hyundai Atos Multi 1.0
0.27
Citroën Xantia 1.8i
0.55
Renault Twingo 1.2 inj
0.28
Mazda 626 2.0
0.58
Daewoo Matiz
0.33
BMW 316
0.74
Cost per kilometre including gas, maintenance, debit, etc. Price level 2002.
Calculations based on over 2,5 years use and 40.000 km.
(Consumentenbond, Augustus 2003)
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Assumptions
 Agreement
on the budget
 Assumption of scarcity
 Possible
to moves between budgets
 We can buy a Suzkie or a BMW
 Agreement
on outcome
 What are the intended effects
 The effects is restricted to ‘movement’
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Which costs included in CE
youth intervention?
 Costs
of intervention
 Costs of alternatives
 Jail
 Other treatment
 Costs
of crime
 Other
savings
 Material costs
 Cost of law enforcement
 Broken education
 Intangible costs
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Intangible costs
 What
are the costs of
 Death
 Suffering
 Rape
 Fear
 No
clear methodology
 Willingness to pay
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Which outcomes in youth
interventions?
 What
is the aim of youth interventions?
 Costs per avoided crime
 Costs per contact
 Prevention
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Effects expressed as costs
 Cost
Benefit analysis
 Effects can now be subtracted from costs
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Drivers in health economics
 The
effect of the intervention
 The cost of the intervention
 Intangible costs
 Discounting
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Changes of economics in youth
interventions
 The
effect of the intervention
 The cost of the intervention
 Alternative is expensive: Jail
 Intangible
costs
 The effects are warranted
 Broken education
 Discounting
 Sometime immediate effects
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Threats of economics in youth
interventions
 The
effect of the intervention
 The
cost of the intervention
 Low quality evidence on the effectiveness
 A randomized trials is now the standard
 Expensive labour-intensive
 Intangible
costs
 No consensus about these costs
 Discounting
 Often effect are in the further: prevention
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Examples
 The
Washington State Institute for Public Policy
 Steve Aos, 2004
 Taxpayer perspective: cost benefit analysis
 Intangible costs used as effects (sexual abuse
 The
= $ 94,506)
monetary value of saving a high-risk youth
 Cohen, 1998
 Intangible costs: lifetime costs criminal career
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Little studies
 Welsh
& Farrington, 2000
 “[…] little is known about the economic efficiency of
correctional intervention strategies. A review of the literature
revealed only seven published studies that have presented
information on monetary costs and benefits”.
 Swaray
et al, 2005
 Found only 10 studies
 The
norm ‘evidence based’ is not near
 Research dominated by aetiology and epidemiology
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Encouraging results
 Reviews
show favorable results
 Cure is more cost effective than prevention

• Targeted prevention works better
Cure more cost effective than incarceration
 No
Dutch evidence
 Although The Netherlands is leading in health economics
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Conclusion
 Economics
are lacking
 Main obstacles
 Convincible effect studies
 The
odds are favorable
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