Transcript Document 7844396

Monday, Sept. 24: Applications of costeffectiveness analysis
by
Donald S. Shepard, Ph.D.
Schneider Institute for Health Policy
Heller School, MS 035
Brandeis University
Waltham, MA 02454-9110 USA
Tel: 781-736-3975 • Fax: 781-736-3965
Web: http://www.sihp.brandeis.edu/shepard
E-mail: [email protected]
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Practical information
• Teaching assistant:
[email protected]
• Administrative assistant:
Linda Purrini, Next to library in Heller
781-736-3930
[email protected]
• Cost of packet: $6.00
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Cost-effectiveness ratio
• Numerator: net use of health resources
• Denominator: net improvement in QALYs
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Standard reference case
• Standard set of assumptions for consistent
analyses
• Comparator is the status quo
• Uses a discount rate of 3%
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Disease burden exercise
• Illustrate the calculation of PDLLs from
exercise on web site
• http://www.sihp.brandeis.edu/shepard
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Vaccinations in Ecuador*
• Sources of data
• Incremental cost-effectiveness analysis
*Shepard, D. et al, "Cost Effectiveness of
Routine and Campaign Vaccinations in
Ecuador," Bulletin of the World Health
Organization 1989; 67:649-662.
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Cost per dose by facility and type of
strategy
Number of facilities
Mean
In number of
In country sample
doses
Routine Vaccinations
Hospitals
114
7
4008
Health centres
64
0
21454
Subcentres
617
7
2100
Health posts
232
8
952
Total
1217
22
6368
PREMI campaigns
Hospitals
114
Health centres
54
Subcentres
817
Health posts
232
Total
1217
7
9
4
8
9
30
1320
2653
494
188
809
Average cost
per dose
$0.24
$0.33
$0.41
$0.29
$0.29
(±0.15)
$0.94
$0.75
$0.80
$1.08
$0.83
(±0.07)
(±0.08)
(±0.16)
(±0.07)
(±0.09)
(±0.06)
(±0.06)
(±0.10)
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Table 2: Costs and cost-effectiveness
of vaccination strategies
Indicator
Strategy
Routine
PREMI
services
campaign
Both
combined
No. of doses
2 300 000
2 000 000
4 300 000
Cost per dose'
$0.29
$0.83
$0.55
National cost
$675 000
$1865 000 $2,340,000
No. of FVC
154 000
194 000
347 000
Cost per FVC
$4.39
$8.60
$6.74
Death equivalents
averted
347
394
741
Cost per death
equivalent averted
$1,900
$4,200
$3,200
Cases averted
81 100
95 300
158 400
Cost per case averted
$11.05
$17.47
$14.96
*1985 prices in US$. ° FVC=fully vaccinated children.Schneider Institute for Health Policy
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Fig. 4: Fully vaccinated coverage rates
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Fig. 5: Cost-effectiveness of routine and
PREMI strategies
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Cost per dose, notes
Per sampled facility from records of sampled facilities. In dollars. 1985
prices. Routine vaccinations are based on data for the calendar year
1965. Free market exchange rate was 115.52 sucres=US$ 1.00. In fixed
facilities.
Figures in parentheses are standard errors. ' Health contras were not
included in the sample for routine vaccinations. Mean number of doses
and average cost ware approximated by interpolation between hospital
and subcentre average cost figures. Mean number.
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Cancer Exercise 1
Prepared at the Heller School, Updated September, 2001
Please read the following exercise on colon cancer testing and
discuss the questions at the bottom of this page.
Suppose that the Massachusetts government has set up a program
to test for colon cancer in people enrolled in the state Medicaid
program, which offers health care to low income people and their
families. The test allows doctors to find colon cancer at an early
age. So far, the state government has offered the test to people at
high-risk for colon cancer and has prevented many of them from
dying of colon cancer. Now, the government wants to offer the test
to the rest of the people receiving Medicaid, all of whom are at
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equally
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low risk for colon cancer.
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Cancer Exercise 2*
An advisory committee of doctors was formed to help the
government to decide which of two tests to offer the low-risk
people. Test 1 is inexpensive but does not always detect cancer in
the early stages. Test 2 is more expensive but is better at detecting
early cancers. The decision is complicated by budget limitations:
the government has only a certain amount of money available to
pay for the screening tests. After evaluating the costs and benefits
of each test, the doctors have reached the following conclusions.
* Adapted from Uble, P.A., DeKay, M.L., Baron, J., Asch, D.A.
“Cost-Effectiveness Analysis in a setting of Budget Constraints”
The New England Journal of Medicine 1996; 334; 1174-1177.
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Cancer Exercise 3
Test 1: The budget is just large enough to offer Test 1 to all the
low-risk people. With this approach, everyone can receive the test,
and 1,000 deaths from colon cancer will be prevented.
Test 2: The budget is just large enough to offer Test 2 to half of the
low-risk people. With this approach, half the people can receive
the test and half cannot, and 1,100 deaths from colon cancer will
be prevented. The persons eligible for the screening test would be
selected randomly according to their security numbers.
Please select which of the tests the advisory committee should
recommend and provide the reasons for your selection.
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