Transcript ForCA lezing

Kosteneffectiviteit: een kans
voor effectieve behandelingen
 Prof.
dr. Jan van Busschbach
 Viersprong Institute for studies on Personality Disorders

• VISPD
Erasmus MC
• Department of Psychiatry
 [email protected]
 ForCA,
25 november 2013, Utrecht
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Economics
1.
2.
3.
Costs and effects
Choice
Perspective
2
1. cost and effects
3
Costs of crime prevention
Moolenaar et al. (2011)
4
Effects
 Less
crime
 More school attendance
 Better quality of life
 Victim
 Criminal person
5
2. choice
Costs A
Intervention A
Outcomes A
Difference
Choice
Costs B
Intervention B
Outcomes B
6
‘Full’ economic evaluation
Are both costs (inputs) and consequences
(outputs) examined?
No
Yes
Is there a
comparison
of two or
more
alternatives?
Only
consequences
Only costs
No
Outcome
description
Cost
description
Cost-outcome
description
Yes
Efficacy or
effectiveness
evaluation
Cost
analysis
Full economic
evaluation
Drummond et al. (2005)
7
3. Perspectives
 Insurance
 Payers perspective
 Government
 Local government
 Societal
 Tax payers
8
Societal perspective
 All
costs, all effects
 No matter who gets them
 Life
time costs
 Not only for duration of intervention
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Aos et al. (2004)
An example:
Tax payers perspective
10
What they did….
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High costs victims
The public costs and benefits per participant of the High/Scope
Perry Preschool Study (Schweinhart, 2003)
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Variance in price of crime to victims
Mean
Median
Standard Deviation
$1,445,463
$1,380,246
$771,395
Rape
149,542
23,143
355,583
Robbery
279,085
88,915
452,485
Assault
134,770
66,644
212,510
Burglary
4,444
814
384,591
Motor Vehicle Theft
15,175
6,174
76,477
Theft
1,996
192
459,817
Crime Type
Murder/Non-negligent
Manslaughter
Relate costs to effects in
natural units
 Cost
benefit
 Cost
effectiveness
 Effects are expressed as costs
 Effects: ‘natural units' relevant to the intervention
 Examples
 Cost per avoided crime
 Cost per school return
 Cost per prevented out-of-home placement
 Problem:
 How can we make cost-effectiveness results comparable to
other interventions for which budgets should be allocated?
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Health Economics
 Comparing
different allocations
 Should we spent our money on


• Wheel chairs
• Screening for cancer
Comparing costs
Comparing outcome
 Outcomes
must be comparable
 Make a generic outcome measure
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Outcomes in health economics
 Specific
outcome are incompatible
 Allow only for comparisons within the specific field
• Clinical successes: successful operation, total cure
• Clinical failures: “events”
“Hart failure” versus “second psychosis”
 Generic
outcome are compatible
 Allow for comparisons between fields
• Life years
• Quality of life
 Most
generic outcome
 Quality adjusted life year (QALY)
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Quality Adjusted Life Years (QALY)
 Example
 Blindness
 Quality of life value is 0.5
 Life span = 80 years
 0.5 x 80 = 40 QALYs
1.00
X
0.5 x 80 = 40 QALYs
0.00
40
80
Life years
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17
Area under the curve
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7000 Citations in PubMed
Publications
1980[pdat] AND (QALY or QALYs)
1000
900
800
700
600
500
400
300
200
100
0
1975
1980
1985
1990
1995
2000
2005
2010
2015
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Criminal activity free year: CAFY
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Societal perspective: Include a
wide range of costs
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Life time cost and effects: modelling
1 minus effect
of intervention
1
Costs criminal
Costs dead
Natural mortality rate
A - criminal
C - dead
Probability of
relapse
Effect of
intervention
Natural mortality rate
B – not criminal
+ Costs intervention
1 minus probability of
relapse
Costs not
criminal
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Petrou & Gray (2011)
Costs and effects I
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Choice and uncertainty
100% < € 20.000
90% < € 0
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Few cost-effectiveness studies
 Only
a few follow the guidelines
 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”
 Soeteman
 12 studies
& Busschbach, 2008
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Markov model
27
Choice: CEAC
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Conclusions
 Not
much work has yet been done in The
Netherlands
 Cost of crime is complex to estimate
 What categories should be included?
 How should you estimate these costs?
 Cost
effectiveness might be a new approach
 Cost per avoided crime
 Cost per CAFY
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Types of full economic
evalutation
Method
Comparison
Cost minimisation
analysis (CMA)
Yes
Costs
Monetary
units (€)
Cost effectiveness
analysis (CEA)
Monetary
units (€)
Cost utility analysis
(CUA)
Cost benefit analysis
(CBA)
Yes
Yes
Yes
Monetary
units (€)
Monetary
units (€)
Outcomes
No difference in
outcomes
Natural units (life years
gained, point blood
pressure, etc.)
Utilities and Quality
adjusted life years
(QALYs)
Monetary units (€)
Drummond et al. (2005)
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