CAP Lecture 2

8/18/2019 CAP Lecture 2

1/25

Health Economics for Prescribers Lecture 2: Pharmaco-economic evaluation – research question

Health Economics for Prescribers

Richard Smith (MED)[email protected]

David Wright (CAP)[email protected]


2/25


Workshops

Fcus ! "ractica# critica# a""raisa# $ "u%#ished "a"er&• 'ru" Cte et al. A "harmac*+%ased hea#th "rmti!

"rgramme i! h*"erte!si!. Pharmacoecon, -/0 -1& 213+2-4.5Cst+%e!e6t a!a#*sis $ a "harmac* i!terve!ti! $r h*"erte!si!7

•

'ru" 8 Scu9ham : Cha"#i!. A! ec!mic eva#uati! $;uvastati! used $r the "reve!ti! $ cardiac eve!ts $##wi!gsuccess$u# 6rst "ercuta!eus cr!ar* i!terve!ti! i! the check#ist items 1, -, / a!d 2+? (re& csts)

Wrksh" - > check#ist items 2+? (re& %e!e6ts) a!d ,4,,1 Read paper and checklist prior to workshop


3/25


Overview of next 4 lectures

Lecture 2 – the research question• What ("harmac)ec!mic eva#uati! is, i!trduce Bcheck#ist $r

critica# a""raisa#, cver items 1,-,/ $ check#ist (s"eci6cati! $uesti!, cm"aratr(s), evide!ce $ e9ective!ess)

Lecture 3 – resources and costs• w resurce use c!ce"tua#ised, ua!ti6ed a!d va#ued > items

2, 3, ?, , 4 $ check#ist (im"rta!ce $ resurce use versusBcst, t*"es $ cst, which csts t i!c#ude, verheads,discu!ti!g)

Lecture 4 – benefts and outcomes• w utcmes c!ce"tua#ised, ua!ti6ed a!d va#ued > check#ist

items 2, 3, ? (cst versus %e!e6t, measures $ e9ective!ess,uti#it* a!d the m!e* va#ue $ Bhea#th $r use i! CEA, C


4/25


Lecture 2: Pharmaco-economic

evaluation research !uestion

Ihe Bwh* a!d what $ ec!miceva#uati! (check#ist item 1)

w it re#ates t ther $rms $eva#uati! (check#ist item -) I*"es $ ec!mic eva#uati!

(check#ist item /) Stages i! a! ec!mic eva#uati! Check#ist $r a""raisa# Htems 1, - a!d / summar*


5/25


6/25


Wh$ Economic Evaluation%

Scarcit* J chice J va#ue $ %e!e6ts (""rtu!it*cst) J eKcie!c*

Ec!mic eva#uati! measuri!g va#ue $a#ter!ative curse $ acti! (""rtu!it* cst agai!)

L""rtu!it* cst $rces ide!ti6cati! $ re#eva!ta#ter!atives

Assessme!t $ Bva#ue makes e"#icit im"rta!ce $view"i!ts > a! a#ter!ative that seems u!attractive$rm !e "i!t $ view ma* seem mre attractive

$rm a!ther (cst t !e is %e!e6t t a!ther) Na#uati! reuires va#ue judgeme!ts t %e made

e"#icit Measureme!t e!a%#es u!certai!ties surru!di!g

rders $ mag!itude t %e assessed


7/25Health Economics for Prescribers Lecture 2: Pharmaco-economic evaluation – research question

Economic evaluation is &

OIhe cm"arative a!a#*sis $ a#ter!ativecurses $ acti! i! terms $ %th theircsts a!d c!seue!ces i! rder t assist

"#ic* decisi!s (Drumm!d et a#) Ec!mic eva#uati! is not Ochsi!g

the chea"est•

OIhe "ursuit $ eKcie!t "ractice is !tmere#* a%ut reduci!g csts. H$ it were themst eKcie!t "rcedure wu#d %e t d!thi!g as that "ushes csts t Qer (A#a!Ma*!ard)


8/25Health Economics for Prescribers Lecture 2: Pharmaco-economic evaluation – research question

Histor$ of economic evaluation

Rts i! attem"ts t de6!e a!d va#ue "u%#icgds i! 1th ce!tur*

Practica# deve#"me!t resu#t $ Federa#Gavigati! Act, 1/?• reuired


9/25


Histor$ of 'health( economic

evaluation

13s > ec!mists %ega! t a""#*ec!mic ther* t hea#th care

1?s > cst+$+i##!ess studies %ega! t

emerge 1s > cst+%e!e6t approach acce"ted%ut m!e* va#ue $ hea#th Bdismissed

14s > a#ter!ative utcme measures#ed t CEAC re+emerge!ce $ i!terest i! CA > $rma# ad"ti! %* regu#atr* %dies

-s +i!tegrati! $ CA a!d C


10/25


)mportant features of economic

evaluation

OIhe comparative a!a#*sis $ a#ter!ativecurses $ acti! i! terms $ %th theircsts and c!seue!ces i! rder tassist "#ic* decisi!s (Drumm!d eta#)

1. Csts a!d c!seue!ces > eKcie!c*

-. Cm"aris! > tech!ica# eKcie!c*

/. Assist + !t re"#ace + decisi! maki!g


11/25


Place of economic evaluation in the

wi*er "evaluation c$cle#

needs

assessment

programplanning

program

implementation

process

evaluation

Economic

Evaluation

S t a r t s H e r e

outcome

evaluation

evaluability

assessment

impact

evaluation

1. Can it work (efficacy)?

2. oes it work (effectiveness)?

!. "s it wort# doing (efficiency)?


12/25


+haracteristics&

Ec!mic eva#uati! has -characteristics

1. i!"uts a!d ut"uts (csts a!dc!seue!ces)

-. chice %etwee! at #east - a#ter!atives

Chice

Prgramme A

Cm"aratr Csts

Csts

A

C!seue!cesA

C!seue!ces


13/25


&*etermine forms of evaluation

NO YES

Examines onlyconsequences

Examines onlycosts

1A PARTIAL EVALUATION 1B

$ %utcome

description.

$ Cost description.

3A PARTIAL EVALUATION 3B

$ &fficacy oreffectiveness

evaluation.

$ Cost analysis.

PARTIAL EVALUATION

$ Cost'outcome description.

! "ULL E#ONO$I# EVALUATION

$ Cost'minimisation analysis.$ Cost'effectiveness analysis.$ Cost'utility analysis.$ Cost'benefit analysis.

NO

YES

1. re bot# costs (inputs) and conseuences (outputs) e*amined?

2 .

( r e a t l e a

s t 2 a l t e r n a t i v e s

c o m p a r e d ?


14/25


,$pes of economic evaluation

,$pe of nal$sis .esult +onse!uences+osts

Cost +inimisation

Cost ,enefit

Cost -tility

Cost &ffectiveness

+oney

Single or multiple effects

not necessarily common.

/alue* as utility/ eg.

0

ifferent magnitude of a

common measure eg.3

4s gained3 blood

pressure reduction.

east cost alternative."dentical in all

respects.

+oney

+oney

+oneyCost per unit of

conseuence eg. cost

per gained.

Cost per unit of

conseuence eg. cost

per 0.

s for C- but

value* in money.

5et 6

cost7 benefit ratio.


15/25


0ta1es in economic evaluation

eciding upon study uestion$ 8iewpoint taken.$ lternatives appraised.

ssessment of costs and benefits$ "dentification of relevant C9,.$ +easurement of C9,.$ 8aluation of C (9,).

d:ustment for timing.

+aking a decision.

d:ustment for uncertainty.


16/25


+ritical appraisal

Sta!dard Bcheck#ist $r critica# a""raisa# is&• Drumm!d et al. Methds $r the ec!mic

eva#uati! $ hea#th care "rgrammes, cha"ter /.

A#s ther Bguide#i!es• Drumm!d : Ue9ers!. 'uide#i!es $r authrs

a!d "eer reviewers $ ec!mic su%missi!s tthe MU. BMJ 1?0 /1/& -3>-4/.

• GHCE. 'uide t the Methds $ Iech!#g*A""raisa#. A"ri# -2.

• Etc


17/25


"rummon*# checklist

1. Was a we##+de6!ed uesti! "sed i! a!swera%#e $rmV

-. Was a cm"rehe!sive descri"ti! $ a#ter!atives give!V

/. Was there evide!ce that e9ective!ess had %ee! esta%#ishedV

2. Were a## the im"rta!t a!d re#eva!t csts a!d c!seue!ces $reach a#ter!ative ide!ti6edV

3. Were csts a!d c!seue!ces measuredaccurate#*a""r"riate#*V

?. Were csts a!d c!seue!ces va#ued credi%#*V

. Were csts a!d c!seue!ces adjusted $r di9ere!tia# timi!gV

4. Was a! i!creme!ta# a!a#*sis "er$rmedV

. Was a##wa!ce made $r u!certai!t*V

1. Did "rese!tati!discussi! $ resu#ts i!c#ude a## issues $c!cer!V


18/25


+hecklist item 3

Was a well-defned question posedin answerable orm?

•

Des the stud* eami!e %th the csts a!dc!seue!ces $ each a#ter!ative(determi!es i$ it is a! ec!mic eva#uati!)V

• Des the stud* cm"are cm"eti!g

a#ter!atives (shu#d %e ide!ti6ed : justi6ed)V

• Des the stud* state the view"i!t("ers"ective) take!V


19/25


)mportance of viewpointperspective

A#ter!ative "ers"ectives• 'ver!me!tGS• hea#th care i!stituti!s (hs"ita# etc)• /rd "art* "a*ers (PCI, i!sura!ce cm"a!*)• "atie!t a!d $ami#*• Bscieta#

Methd#gica# decisi! + determi!es what csts a!dc!seue!ces t measure a!d hw t va#ue them

Fr i!sta!ce, "rgramme #eadi!g t ear#* dischargema*•

"rvide cst+savi!gs t hs"ita#GS as shrter i!"atie!t sta*• %ut what i$ a $ami#* mem%er has t take time 9 t care $r

themV

Scieta# "ers"ective is recmme!ded as i!cr"ratesa## csts a!d a## c!seue!ces regard#ess $ wh i!cursthem


20/25


E1 - costs an* outcomes relevant to

*ifferent 1roups

&valuation of antenatal care programmes

Healt#aut#ority

2nd levelproviders

1st levelproviders

Service users

;esourceuse

Contractcosts forcare<reimbursedcare costs

=ests andimaging%utpatientattendances,ed days=ransport

>


21/25


+hecklist item 2

Was a comprehensie descriptiono alternaties !ien?

•

Ca! *u te## wh did what, t whm,where a!d hw $te! (determi!es ran!e $ csts a!d %e!e6ts)V

• Were a!* re#eva!t a#ter!atives mittedV

• Was (shu#d) a Bd+!thi!g a#ter!ative(%e) c!sideredV


22/25


+omparator

A! idea# eva#uati! wi##• cm"are a## "ssi%#e "rgrammesi!terve!ti!s

with each ther a!d a Od !thi!g "ti!

H! rea#it*• resurces t u!dertake eva#uati!s are #imited

H! ge!era# eva#uati!s shu#d seek t at#east justify chice $ cm"aratr,es"ecia##* eisti!g "ractice (status u)

Wrd $ war!i!g• t cm"are a !ew i!terve!ti! with !

treatme!t whe! !e curre!t#* eists a!d issta!dard "ractice is dece"tive


23/25


Problems choosin1 the comparator

estPracticeV

Curre!tPractice

Gew Frm $

Care

Resurce A

Resurce

1

/

-

2Pssi%#e %udget

cm%i!ati!s$ A a!d

Pssi%#e ut"utcm%i!ati!s


24/25


+hecklist item 5

Was there eidence that the pro!rammes e"ectieness had beenestablished?

• Was this d!e thrugh a RCIV H$ s, did thetria# re;ect "racticeV

• Were e9ective!ess data c##ected thrugh a

s*stematic reviewV• Were %servati!a# data used > what are the

"ssi%#e %iasesV

• What was measure $ e9ective!essV


25/25


6seful website

GS Ec!mic Eva#uati!s we%site&

http://www.york.ac.uk/inst/crd/nhsd

faq.htm

Fu!ded %* D t s*stematica##* ide!ti$*, a""raisea!d s*!thesise ec!mic eva#uati!s t su""rt

decisi!+makers withi! the GS.

Date post:	06-Jul-2018
Category:	Documents
Upload:	allen-reynaldi
View:	214 times
Download:	0 times

CAP Lecture 2

Documents