Transferability of - PowerPoint Presentation

Slide1

Transferability ofEconomic Evaluation ResultsBetween Countries

Group Three

Dorian

Herceg

Ashley Jenkins

Viraj

Kasbekar

Annie Kirkwood

Radhika

KulkarniSlide2

Introduction Transferability factors

Knock-out Criteria

Modeling adjustments

Degree

of

transferability

Corrections

for different currency and purchasing

power

Transferability

decision chart applied to

:

Case

1 -

Germany

Case

2 -

Netherlands

Case

3 -

Denmark

Link

to Brown et al.

article

Conclusion Slide3

Determining Transferability Factors

Definition: The

quality of being transferable or

e

xchangeable

Two

Approaches

Systematic identification of potential transferability factors

Literature review

Four Characteristics the Potential Factors Had to Possess

Influence on outcomes of economic evaluations

International variation

Measurability

Distinguishable from other factors, i.e. they should overlap with other factors as little as possibleSlide4

Table I. Final and potential transferability factors

Final transferability factors Potential transferability factors

Methodological characteristics

Perspective

Perspective

; discount rate; medical cost approach (charges, fees, prices); productivity

Discount rate cost approach (friction cost method, human capital approach, QALYs); considered

Medical cost approach costs and effects

Productivity cost approach

Healthcare system characteristics

Absolute and relative prices in healthcare Absolute prices; relative prices; practice variation; staff characteristics; Practice variation characteristics and learning effects of physicians; nurses and hospitals; liability of Technology availability physicians; type of healthcare facility;

organisational

characteristics; place of technology; technology availability; range of licensed products; availability of generics; competition; market form of suppliers; payment of suppliers; incentives to suppliers; supplier-induced demand; healthcare delivery structure; waiting lists; referral patterns; healthcare before and after intervention; quality of care; capacity

utilisation

; economies of scale

Population characteristics

Disease incidence/prevalence Disease incidence/prevalence; case-mix; age; sex; race; education; socioeconomic

Case-mix status; disease severity; co-morbidity; medical history; concurrent medications;

Life expectancy susceptibility; progression of disease; natural history of the disease; lifestyle; risk

Health-status preferences

factors

; environmental factors; genetic factors; cultural aspects; care-seeking

Acceptance, compliance, incentives to patients

behaviour

; hygiene; reproduction; life expectancy; health-status preferences;

Productivity and work-loss time methods to measure health-status valuation; technology acceptance; Disease spread compliance;

incentives

topatients

; insurance level; co-payments; moral hazard;

productivity

; work-loss

time; friction

time; income level and distribution;

disease

spread; population

density;

immigration

;

emigration

; travelling;

ethical

standardsSlide5

General Knock – Out CriteriaKnock-out criteria of transferability can be described as criteria that make the transfer of study

results always

impossible or so troublesome that conducting a new study is the better option.

If any of the following criteria apply then it is almost impossible to transfer study results from one country to another

The evaluated technology is not comparable to the one that shall be used in the decision country

The comparator is not comparable to the one that is relevant to the decision country

The study does not possess an acceptable qualitySlide6

Specific Knock-Out CriteriaEach factor can become a knock-out criteria if It cannot be assessed because of lack of data from the study or the decision country

Technologies incorporatedSlide7

Knock –out Criteria ConclusionIf either knock-criteria are present then study results are not transferable

If both criteria are not present then you assess whether modeling adjustments are necessarySlide8

Modeling AdjustmentsAlways necessary when big differences between the study country and decision country are present for

Practice variation

Relative prices or incidence/prevalence of the respective target disease

Also, every other transferability factor can also cause need for remodeling

If necessary, identify if study/data methods complete and then if data is available )new parameter and new CER, and sensitivity analysis)

If not necessary, study results fully transferable or needing higher transferability)Slide9

Degree of TransferabilityIdentify if study/data methods completeIf no, not transferable

If yes, identify if relevant decision country data available

Fully available

Substitute all parameters and calculate new CER

Partially available

Substitute all parameters and calculate new CER

Re-apply checklist or perform sensitivity analysis

Either transferable or not transferable

Not available

Assess variability of parameters and perform sensitivity analysis

Either transferable or not transferableSlide10

Correction for Different Currency or Purchasing Power as Well as Inflation

Correction for Different Currency or Purchasing Power

Purchasing power parities (PPPs)

Correction for Inflation

The healthcare-specific price indices

GDP-price indexSlide11

Application of the Transferability Decision Chart

Case 1 – Germany

Cost effectiveness of

stenting

technology compared with PTCA for patients with coronary heart disease.

Case 2 – Netherlands

Cost effectiveness of current and future vaccine candidates - National Vaccine Program

Case 3 – Denmark

Cost effectiveness of a systematic

chlamydial

screening program of asymptomatically infected individualsSlide12

Case 1 – Germany

Of all the studies under consideration , only two studies met Knock-out criterionSlide13

Case 2 – The Netherlands Slide14

Case 3 – DenmarkDanish researchers intented

to transfer Dutch CEA Model to evaluation cost effectiveness of large-scale

chlamydial

screening

programme

which would save on time and cost of conducting the evaluation

Constraints in transferability:

Divergence in two

programmes

with regards to screening approach, partner tracing

programme

as well as comparator

As a result, transfer of study results not possible.

Assessment of transferability of model:

Entailed two sub-models: epidemiological and economical

Parameters from

eidemiological

model like partner mixing, number of partners and nature of infection including the prevalence data seemed transferable without any need for adjustments, whereas only testing probability and contraction needed correction.

To apply the economic model, Danish parameters for utilization and valuation of resources consumption had to be totally replaced , additionally a new model to predict cost of test and partner referral createdSlide15

Connection to Brown et al.

Transferability by Robert

Welte

article can be applied to Brown

article

How

?

Transfer of economic evaluation results

Goal

– cost effectiveness of ERT compared to

radiotherapy alone

Funding based on

cost-effectiveness

This study varied substantially across countries

Relevant data was established for each country in order for transferability of information

Had to take these changes into consideration (e.g. sensitivity analysis on lifetime cost-utility analysis)

Discount rate, Radiotherapy

admission

costs, Costs

of adverse event

treatment, Acute

health state utilities, etc.Slide16

Questions