1 / 38

Assessing Health and Economic Outcomes

William C. Black, M.D . Director ACRIN Outcomes & Economics Core Laboratory Dartmouth-Hitchcock Medical Center. Assessing Health and Economic Outcomes. Background Health outcomes Economic outcomes Cost-Effectiveness Analysis. Outline. Geography is destiny More is not better

tam
Download Presentation

Assessing Health and Economic Outcomes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. William C. Black, M.D. Director ACRIN Outcomes & Economics Core Laboratory Dartmouth-Hitchcock Medical Center Assessing Health and Economic Outcomes

  2. Background Health outcomes Economic outcomes Cost-Effectiveness Analysis Outline

  3. Geography is destiny More is not better Patient preferences matter “Outcomes”

  4. US Health Care Expenditures http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage

  5. Health Expenditures by Country, 2006

  6. Life Expectancy by Country

  7. Growth in physician services

  8. Determine what works Assess pt preferences Deliver appropriate care “Outcomes”

  9. Hierarchical Model of Efficacy Level 1. Technical Level 2. Diagnostic accuracy Level 3. Diagnostic thinking Level 4. Therapeutic Level 5. Patient outcome Level 6. Societal Fryback & Thornbury. Medical Decision Making 1991;11:88-94.

  10. SE = Pr(T+| D+) SP = Pr(T-| D-) Az = Area under ROC curve Accuracy

  11. Baseline Values P 0.5 B, C 1.0 LEN 2.0 LED 0.0 SE, SP 0.8

  12. Treat 1.0 Test 1.3 No Treat 1.0 Expected Utility

  13. Disease spectrum Accuracy of test Natural History of dz Effectiveness of treatment Limitations

  14. Randomized Clinical Trial To ensure that observed differences in outcome depend only on the interven- tions under investigation and not on other factors that affect outcome.

  15. Measure Health Related QOL Measure costs Analyze cost-effectiveness Outcomes & Economic Core Lab

  16. Global rating Symptoms Functional status Health Related QOL

  17. Non-preference based Generic, e.g., EVGFP, SF-36 Disease-specific, SAQ Preference based Direct, e.g., VAS Indirect, e.g., SF-6D Health Related QOL

  18. Rating scale Standard gamble Time-tradeoff Measuring Preferences - Direct

  19. Visual Analogue Scale

  20. Standard Gamble

  21. Quality of Well Being Health utilities index EuroQoL-5D Short Form -6D Measuring Preferences - Indirect

  22. SF-6D • Physical functioning • Role limitations • Social functioning • Pain • Mental health • Vitality

  23. Brazier et al. J Health Econ 2002;21:271-92. SF-6D Utility Scoring U = 1.000 + ∑Score – 0.070

  24. Quality Adjusted Life Year • Measure of patient utility • Measured on a scale of 0-1.0 • Can be assessed directly or derived from health survey, e.g., SF-36

  25. Quality Adjusted Life Years 1.0 QALY = 0.5+0.25 = 0.75 Quality of Life 0.5 0 0.5 1.0 Quantity of Life

  26. Direct inpatient care outpatient care medications Indirect time and travel Economic Outcomes

  27. Triggered by patient questionnaire ICD-9, DRGs, and CPTs coded by MRA Medicare reimbursement Part A MEDPAR Part B Physician Fee Schedule Hospitalization Costs

  28. Triggered by patient questionnaire ICD-9 and CPTs coded by MRA Medicare Physician Fee Schedule Red Book avg wholesale prices Outpatient Costs

  29. Triggered by patient questionnaire Travel and other expenses Timefrom usual activities Indirect Costs

  30. Societal perspective In-trial and lifetime horizons Discounting @ 3% Sensitivity analysis CEA

  31. Incremental Cost Effectiveness Ratio ∆COSTS ∆QALYS ICER =

  32. c cost K II IB IA effect IIIA IIIB IV Black. Med Decis Making 1990. 10(3): 212-4.

  33. STRATEGY COST QALYS CER Do Nothing Do Something Comparison 0 0 NA $100,000 4 $25,000

  34. Chart Abstraction Process

  35. Summary • Variation in practice • Rising costs unsustainable • Radiologic imaging target • “Outcomes” data collection essential • Role of cost-effectiveness analysis

More Related