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Make Nutrition Services Count:Cost-Effectiveness Research
& Outcomes Research
Outcomes Researchand Cost Effectiveness
Setting value to what we do
ADA’s Commitment to Cost Effectiveness
National Academy of Sciences Report Dietetics Outcomes Research Steering
Committee Health Services Research Committee Quality Management Committee Lewin Study
Define outcomes / CE terms
Methods of evaluation in health care
Distinguish the features of cost-effectiveness research
Identify barriers/ limitations and resources in conducting CE studies
Identify activities that may promote CE studies
Objectives:
OutcomeOutcomeThe result of the performance (or
nonperformance) of a function or process(es). JCAHO 1996
Outcome IndicatorOutcome IndicatorMeasures what happens (or does not
happen) to a patient after something is done (or not done) to the patient. NLHI
Terms
Cost Benefit AnalysisCost Benefit AnalysisAn analytic tool for estimating the net
social benefit of a program or intervention as the incremental benefit of the program less the incremental cost, with all benefits and costs measured in dollars.
Cost Effectiveness in Health and Medicine. Gold, Martha, et al 1996 University Press
Terms
Cost EffectivenessCost EffectivenessAn analytic tool in which costs and effects
of a program and at least one alternative are calculated and presented in a ratio of incremental costs to incremental effects. Effects are health outcomes such as cases of a disease presented, years of life gained or quality adjusted life years rather than monetary measures as in cost benefit analysis.Cost Effectiveness in Health and Medicine. Gold, Martha, et al 1996 University Press
Terms
QALYQALY“Quality-adjusted life year”
Terms
Terms
DFLEDFLE“Disability-free life expectancy”
Life expectancy free of class I (or worse) disability
Disability classes based on person-trade off method
Terms
DALEDALE“Disability-adjusted life expectancy”
HLHLxx = L = Lxx ( 1 - ( 1 - PPixix DDixix ))
Where:
HLx =the number of years of healthy life lived at age
x
Lx = the number of years of life lived at age x from a
life table
Pix =the prevalence of disabling sequelae j at age x
Dix =the disability severity weight for disabling
sequelae j at age x
Define outcomes / CE terms
Methods of evaluation in health care
Distinguish the features of cost-effectiveness research
Identify barriers/ limitations and resources in conducting CE studies
Identify activities that may promote CE studies
Objectives:
Methods of Evaluation in Health Care
Measurements
A. In natural units on a undimensional scaleB. In units of a cardinal utility function, which is
used to transform the multidimensional concept of ‘health’ into a scalar index’
C. In monetary units
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care
Natural Units:
A clinical parameter - blood pressure Length of life in years
This method only makes sense if the alternatives to be compared have one specific effect and not side effects.
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care
Natural Units:
A clinical parameter - blood pressure– compare two different drugs - no side effects– compare two different diet interventions - no
side effects
OR– two safety measures designed to avoid fatal
traffic crashes
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care: CEA
Method of evaluation would be cost-effectiveness analysis (CEA). Only for mutually exclusive projects.
t1CEA = costs in units of money
benefits in mmHg
and
t2CEA = costs in units of money
benefits in additional life years
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care
Limitations of CEA
Its application implies that who obtains the additional life years is of not relevance
It does not lend itself to the evaluation of projects with several different (positive) effects.
Provides a rank order of preference among mutually exclusive projects, it does not answer the question which of the projects should be realized and which should not
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care
Measurements
A. In natural units on a undimensional scaleB. In units of a cardinal utility function, which is
used to transform the multidimensional concept of ‘health’ into a scalar index’
C. In monetary units
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care: CUA
Method of evaluation that takes account of the multidimensionality of the concept ‘health’ by trying to encompass all effects of an intervention - prolonging life and changing health status.
tCUA = costs in units of money
benefits in QALYsThe index value may be interpreted as ‘QALYs’ gained.
Again, only for mutually exlusive projects.
Unlike CEA, suitable for comparing medical interventions of heterogeneous kind and purpose
Zweifel P: Health Economics, 1997
Methods of Evaluation in Health Care: CBA
Zweifel P: Health Economics, 1997
Monetary equivalents are assigned to prolongations of life and change of health status.
tCBA = costs in units of money
benefits in units of money
Methods of Evaluation in Health Care:
Zweifel P: Health Economics, 1997
Unlike cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis circumvent the problem of monetary evaluation of life and health. However, they provide only a relative evaluation of mutually exclusive projects, while CBA permits evaluation of each
project on its own.
Objectives
Define outcomes / CE terms
Methods of evaluation in health care
Distinguish the features of cost-effectiveness research
Identify barriers/ limitations and resources in conducting CE studies
Identify activities that may promote CE studies
Outcomes ResearchOutcomes Research– Process
Identify the outcome (what we effect) Set a clear definition of the outcome
– Implementation Measure Analyze Evaluate
Features of Cost Effectiveness
Examples of research on Examples of research on indictors:indictors:
AntecedentsEpidemiological term similar to
exposure
_______________________________________
Features of Cost Effectiveness
Examples of outcomes Examples of outcomes research:research:
_______________________________________
Features of Cost Effectiveness
What it is -
What is Cost-Effectiveness?
What it is not-
What it is -“a method for evaluating the health outcomes and resource costs of health interventions”
Russell, et al., JAMA 1996;276:1172
What is Cost-Effectiveness?
What is Cost-Effectiveness?
Interventions– Nutrition Support– MNT Protocols– Presence of the RD on
the health care team, in the public health jurisdiction, etc.
What is Cost-Effectiveness?
Outcomes in CEA– Traditional
Medical Outcomes
– Resource Costs
– Expanded definitionPatient centered outcomes
Quality of life; Client satisfaction
What is Cost-Effectiveness?
Cost-Savings
Cheaper bang
Cost-Benefit Analysis
All benefits cost in dollars
?? Putting dollar value on life years
What it is not -
What it is -
Hoch JS: Health Econ. 11: 415–430 (2002), Published online 31 January 2002 in Wiley InterScience (www.interscience.wiley.com).
Objectives
Define outcomes / CE terms
Methods of evaluation in health care
Distinguish the features of cost-effectiveness research
Identify barriers/ limitations and resources in conducting CE studies
Identify activities that may promote CE studies
Barriers and Limitations
ExpectationsTrainingSupportOutcomes difficult to measureTime of follow-upCo-Morbidity'sResearch training
Strengths
Documentation of worthBenchmark for change
Objectives
Define outcomes / CE terms
Methods of evaluation in health care
Distinguish the features of cost-effectiveness research
Identify barriers/ limitations and resources in conducting CE studies
Identify activities that may promote CE studies
Cost-Effectiveness