Economic evaluations briefly
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Economic Evaluations, Briefly…. CHSC 433 Module 6/Chapter 13 UIC School of Public Health L. Michele Issel, PhD, R N. Objectives. To understand the conceptual basis of economic evaluations Be able to distinguish among the types of economic evaluations

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Economic evaluations briefly

Economic Evaluations, Briefly…

CHSC 433

Module 6/Chapter 13

UIC School of Public Health

L. Michele Issel, PhD, RN


Objectives

Objectives

  • To understand the conceptual basis of economic evaluations

  • Be able to distinguish among the types of economic evaluations

  • Be confident as a participant in a team that undertakes an economic evaluation

  • NOT: be fully competent to do on own!


Be a critical consumer

Be a critical consumer

Not all publications and reports are what they seem or do what they are titled. Be a savvy consumer of economic evaluations…


Types of economic evaluations

Types of Economic Evaluations

  • Cost Description

  • Cost Analysis

  • Cost-Effectiveness

  • Cost-Benefit

  • Cost-Utility

  • Note: These are not mutually exclusive, nor the only way to typify economic evaluations.


Which economic evaluation to do

Which Economic Evaluation to Do?

To formulate the economic evaluation question decide whether:

  • Are 2 or more programs being compared?

  • Are cost only, or costs and impact being considered?


Types of economic evaluations drummond et al 1997

Types of Economic Evaluations (Drummond et al, 1997)


Similarity of process

Similarity of process

  • The steps are basically the same

  • Note: The alternative program can be either the do-nothing option or the “standard treatment”


Terminology to know

Terminology to know

Opportunity Costs

Externalities

Discounting

Inflation

Depreciation

Sensitivity analysis


Steps in cost effect evaluations

Steps in Cost & Effect Evaluations

  • Define program

    • Target population, Interventions to be evaluated, Program goals and objectives

  • Identify the alternatives to be compared

  • Develop decision rules

    • assumptions, definitions


Steps continued

Steps (Continued)

  • Compute costs related to the program(s)

    • Resources utilized by program and by participants

    • Productivity loss/gain of participants, family burden, etc

    • Adjust for time through discounting, inflation, depreciation


Steps continued1

Steps (continued)

  • Identify and measure program impacts or outcomes

  • Compute costs of effects

  • Conduct sensitivity analysis

  • Disseminate findings


Major types of cost analyses

Major Types of Cost Analyses

  • Cost Effectiveness

  • Cost Benefit

  • Cost Utility


Cost effectiveness analysis cea

Cost-Effectiveness Analysis (CEA)

Asks: Does Program A have more effect for the dollars expended than does Program B?

Findings: Specific comparison between programs

C/E ratio is the incremental price to get one unit of effect compared to the alternative


Economic evaluations briefly

CEA

Effects of the programs are measured in natural or physical units of health effects that are common to both programs

QALYs, DALYs, HLYs can be used

Amount of cost per amount of effect for each program

Low C/E ratio is a good buy


Formula for cea ratio

Formula for CEA Ratio

Basically ~

Numerator of Cost $

Denominator of Health Effect Unit

Cost = health care resources + non-health care resources + informal caregiving + participant time


Cost benefit analysis cba

Cost-Benefit Analysis (CBA)

Asks: Are benefits gained worthwhile to society, given the costs?

Findings: Broad, policy implications because of societal focus

Grounded in welfare economics


Economic evaluations briefly

CBA

Benefits (impacts) measured in market value, willingness to pay (WTP), life expectancy. Measures ALL outcomes.

Value in dollars is used to compare programs. Often compare to the do-nothing option.


Formula for cba ratio

Formula for CBA Ratio

Basically ~

Numerator of Cost $

Denominator of Benefit $

Benefit $= participant productivity + gain in taxes + reduction in health expenses + etc...


Cost utility analysis cua

Cost-Utility Analysis (CUA)

Asks: How much is it worth to have a particular state of health?

Findings: Reflect importance; difficult to use for planning or policy because of idiosyncratic nature of preferences.


Economic evaluations briefly

CUA

Measures Used: Utility measures, weighted utility measures.

Utility refers to a preference for a state of health, which is achieved as an impact from the program.


Utility determination

Utility Determination

Example~

Would you rather have sever, chronic hypertension or Type II diabetes?

Would you rather loose right leg or left hand?

Would you rather loose you left hand or have Type II diabetes


Formula for cua ratio

Formula for CUA Ratio

Basically ~

Numerator of Cost $

Denominator of Utility Units


Criteria for assessing published economic evaluations drummond et al 1997 gold et al 1996

Criteria for Assessing Published Economic Evaluations(Drummond et al 1997; Gold et al 1996)

FRAMEWORK:

  • Well defined economic question

  • Description of alternative programs

  • Effectiveness of intervention(s) established


Criteria continued

Criteria (continued)

DATA and METHODS:

  • Costs and consequences/impact identified for alternative programs

  • Appropriateness of units of measure

  • Credible values for costs and consequences/impacts

  • Cost adjustments for timing (discounting, etc)

  • State year and type of currency

  • Software used


Criteria continued1

Criteria (continued)

RESULTS:

  • Sensitivity analysis conducted

  • Graphical presentation of C/E results

  • Any secondary analyses

    DISCUSSION:

  • Limitations of the study

  • Policy implications

  • Intervention implications


Decision balance

Decision Balance


Economic evaluations across the pyramid

Economic Evaluations Across the Pyramid

Note:

Possible at each level

Precision in cost estimation decreases as move down the pyramid


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