Cost-effectiveness of improving medical services in low-res

Cost-effectiveness of improving medical services in low-res Cost-effectiveness of improving medical services in low-res - Start

Added : 2015-12-09 Views :82K

Download Presentation

Cost-effectiveness of improving medical services in low-res




Download Presentation - The PPT/PDF document "Cost-effectiveness of improving medical ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



Presentations text content in Cost-effectiveness of improving medical services in low-res

Slide1

Cost-effectiveness of improving medical services in low-resource settings

Edward Broughton, PhD, MPH, PT

University Research Co.

May 21

, 2014

ebroughton@urc-chs.com

Slide2

Your decision….

2

Slide3

What would you pay?

An error while splinting wrist fractures can cause pain in the 5th digit for ~ 10 hours An effective improvement intervention can avert error What is it worth to you to avoid the error? What is your willingness to pay?

Slide4

What would you pay?

Your choice: this pain for 10 hours or pay $ to not have painHow much are you willing to pay?10 cents?...... $ 100,000?$ 1? …….. $ 10,000$ 10?……. $ 1,000? etc.Please write down your answerThis is your willingness to pay (WTP)

Slide5

What is economic analysis?

Comparative analysis of two or more courses of action in terms of the costs and consequences of an intervention

Different types of analyses:

Cost-minimization

Cost-effectiveness

Cost-utility

Cost-benefit

Slide6

What is cost-effectiveness analysis?

A way to measure efficiency of an intervention in which costs are related to a single common effect

Cost-effectiveness = costs ÷ effects

Cost-effectiveness ANALYSIS is the cost-effectiveness of one intervention relative to a baseline / comparison

Slide7

But we need to know:

Whose perspective?What time-frame?What units of effectiveness?

7

Slide8

Our improvement intervention example

Training / coaching program that prevents errors that lead to adverse event (pain)Before intervention, 50% risk of pain. After intervention, 10% risk of painCost of improvement intervention = $ 100 / patientCost of treating pain = $ 8 / patient (average) but ineffectiveIs intervention cost-effective?

8

Slide9

Important details:

Whose perspective? = Health system What time-frame? = 1 yearWhat units of effectiveness? = adverse event averted or hour of pain avoided or DALY averted or QALY gained

9

Slide10

Cost of improvement intervention

What are the costs above what would happen without the improvement intervention?Staff time costs should be included even if staff were not paid moreAny other costs we should consider?Assume a cost of $ 100 per patient (divided among all patients who benefit)

10

Slide11

Decision tree

11

Slide12

Calculations

12

Incremental cost effectiveness ratio = difference in costs difference in effects ICER = [(0.1 x 100) + (0.9 x 100)] – [(0.5 x 8) + ( 0.5 x 0)]. [( 0.1 x 0 ) + ( 0.9 x 10 )] – [( 0.5 x 0 ) + ( 0.5 x 10 )] ICER = $ 24.00 / hr of pain relief

Slide13

Table of results

StrategyCostIncremental costEffectIncremental effectInc. cost-effectiveness ratioImprove-ment100969 hours of pain avoided4 hours of pain avoided$ 24 / hour of pain avoidedBusiness-as-usual45 hours of pain avoided

All data are per recipient of strategy

Slide14

Cost effectiveness plane

14

Higher cost

Lower cost

More effective

Less effective

Willingness-to-pay threshold

$ 24

1 hr pain relief

Slide15

Cost effectiveness plane

15

Higher cost

Lower cost

More effective

Less effective

Willingness-to-pay threshold

$ 24

Hr of pain relief

Slide16

If we include the economic consequences of the improvement intervention …..

Taking the societal perspective:

Can people work with pain caused by error?

Assuming no work, calculate lost income / productivity

Assume income / productivity = $ 50 / hour

Assume no difference in the cost of treatment ( $ 8 )

Now redo calculations

Slide17

CEA calculation

17

Incremental cost effectiveness ratio =

difference in costs

difference in effects

ICER =

[(0.1 x 100) + (0.9 x(

-500

))] – [(0.5 x 8) + ( 0.5 x(

-500

)].

[( 0.1 x 0 ) + ( 0.9 x 10 )] – [( 0.5 x 0 ) + ( 0.5 x 10 )]

ICER = – $ 48.50 / hr of pain relief

Slide18

Table of results

StrategyCostIncremental costEffectIncremental effectInc. cost-effectiveness ratioImprove-ment– 440–1949 hours of pain avoided4 hours of pain avoided– $ 48.5 / hour of pain avoidedBusiness-as-usual– 2465 hours of pain avoided

All data are per recipient of strategy

Slide19

Cost effectiveness plane

19

Higher cost

Lower cost

More effective

Less effective

Willingness-to-pay threshold

$ 24

- $ 48.5

Slide20

Cost effectiveness plane

20

Higher cost

Lower cost

More effective

Less effective

Willingness-to-pay threshold

$ 24

- $ 48.5

Slide21

Why CEAs of improvements difficult in LMICs?

Often “effectiveness”

is

process

indicator, not

clinical outcome (

eg

: compliance with standard of care)

Difficult to transform into a clinical

outcome

Often improvement has many different effects

Need

modeling to convert to DALYs, QALYs etc.

Need to guess how long improvement

will

last

Data often dubious

No control groups to determine

attributability

Slide22

Clarifying the question

What are you comparing your intervention to?

Doing nothing

Another intervention

Several other interventions

What point of view / perspective are you taking?

Recipient of the intervention

One or several of the funders

Everyone (societal)

Why are you doing the CEA?

Who is your audience?

What is the information going to be used for?

Slide23

Calculating DALYs and WTP

Global burden of disease: 2004 Updatehttp://www.who.int/healthinfo/global_burden_disease/GBD2004_DisabilityWeights.pdf?ua=1DALYs for AE = 10/(365 x 24) x 0.132 = 0.001142 WHO: > 3 x GDPPC / DALY, WB = 1 x GDPPC / DALY For US, $ 178 (WHO) or $ 59 (WB)

23

Slide24

Questions?

24


About DocSlides
DocSlides allows users to easily upload and share presentations, PDF documents, and images.Share your documents with the world , watch,share and upload any time you want. How can you benefit from using DocSlides? DocSlides consists documents from individuals and organizations on topics ranging from technology and business to travel, health, and education. Find and search for what interests you, and learn from people and more. You can also download DocSlides to read or reference later.
Youtube