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Health Economics & Evidence
Based Practice




                            Stephen Kinsella
                                        KBS
                      stephen.kinsella@ul.ie
                     www.stephenkinsella.net
2   Sections
3   Ideas
Microcosting



Simple Clinical    Screening
   Scores         Programmes
<1>
Microcosting
How Much?
Background
Background

McElligott, Kinsella, & Roy (2006,
  2009)
Background

McElligott, Kinsella, & Roy (2006,
  2009)
1 Patient
Background

McElligott, Kinsella, & Roy (2006,
  2009)
1 Patient
Birth at 24 weeks: the marginal case
Background

McElligott, Kinsella, & Roy (2006,
  2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital
Background

McElligott, Kinsella, & Roy (2006,
  2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital

  Q: How much did this cost?
Data
Data
176 variables
Data
176 variables
  
 17 dierent antimicrobials,
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
  
 95 ventilation days
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
  
 95 ventilation days
  
 86 transfusions
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
  
 95 ventilation days
  
 86 transfusions
83 radiological procedures including
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
  
 95 ventilation days
  
 86 transfusions
83 radiological procedures including
  
 47 X-rays, 1 MRI, 35 ultrasound scans (head,
    abdomen, heart)
Data
176 variables
  
 17 dierent antimicrobials,
   479 ‘antibiotic days’
  
 369 ‘diuretic-days’
  
 95 ventilation days
  
 86 transfusions
83 radiological procedures including
  
 47 X-rays, 1 MRI, 35 ultrasound scans (head,
    abdomen, heart)
940 laboratory investigations
Data
176 variables
   
 17 dierent antimicrobials,
    479 ‘antibiotic days’
   
 369 ‘diuretic-days’
   
 95 ventilation days
   
 86 transfusions
83 radiological procedures including
   
 47 X-rays, 1 MRI, 35 ultrasound scans (head,
     abdomen, heart)
940 laboratory investigations
2 x National Neonatal Transport Transfer
Data
176 variables
   
 17 dierent antimicrobials,
    479 ‘antibiotic days’
   
 369 ‘diuretic-days’
   
 95 ventilation days
   
 86 transfusions
83 radiological procedures including
   
 47 X-rays, 1 MRI, 35 ultrasound scans (head,
     abdomen, heart)
940 laboratory investigations
2 x National Neonatal Transport Transfer
Family’s Time, Equipment Maintenance,
  Refurbishment, and more
Day 19 Fungal Sepsis,      Day 202
Transfer to Crumlin     RSV Vaccination
Total Cost



TC = €665,219.88
1 week: cost €5,167.50
Fixed cost: €26,608.00
Conclusion

  Very precise data implies increased
                  cost
TC, MC substantially larger than UK, US
              estimates.
  So What? Vast Budget Implications
/1
2
Simple Clinical Scoring

Kellett et al 2006, 2007, 2008
Simple tests give predictive scores which
save time, effort, money, and, maybe, lives.
Big Q: How much?
Cost Effectiveness of Screening
         for Dementia

      Trepel  Kinsella, 2008, Trepel’s PhD
      Simple Idea, very complex implementation
Cochrane Review on Costing
         Studies
     What methods do people use when making
     ec. evaluations
     What numbers do they get, and why?
     A meta analysis (see poster)
/2
Ching?
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
2.
 HRB Health Research Project grants, see http://
tinyurl.com/axv2hc
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
2.
 HRB Health Research Project grants, see http://
tinyurl.com/axv2hc
3.
 IRCHSS Post Graduate Scholarships, see http://
tinyurl.com/9fqug8
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
2.
 HRB Health Research Project grants, see http://
tinyurl.com/axv2hc
3.
 IRCHSS Post Graduate Scholarships, see http://
tinyurl.com/9fqug8
4.
 IRCSET Post Graduate Scholarships, see http://
tinyurl.com/7frgjk
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
2.
 HRB Health Research Project grants, see http://
tinyurl.com/axv2hc
3.
 IRCHSS Post Graduate Scholarships, see http://
tinyurl.com/9fqug8
4.
 IRCSET Post Graduate Scholarships, see http://
tinyurl.com/7frgjk
5.
 Private Funding opportunities also exist, please
contact me directly for details.
Ching?
1.
 HRB/NCI Graduate fellowships in health
economics, see http://tinyurl.com/a6gbk9
2.
 HRB Health Research Project grants, see http://
tinyurl.com/axv2hc
3.
 IRCHSS Post Graduate Scholarships, see http://
tinyurl.com/9fqug8
4.
 IRCSET Post Graduate Scholarships, see http://
tinyurl.com/7frgjk
5.
 Private Funding opportunities also exist, please
contact me directly for details.
Questions I want to ask
 How much?
 Comparison/Evaluation of different methods
 Tricky data problems
Health Economics  Evidence
Based Practice




                            Stephen Kinsella
                                        KBS
                      stephen.kinsella@ul.ie
                     www.stephenkinsella.net

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Presentation to UL's Medical School on Health Economics

  • 1. Health Economics & Evidence Based Practice Stephen Kinsella KBS stephen.kinsella@ul.ie www.stephenkinsella.net
  • 2. 2 Sections
  • 3. 3 Ideas
  • 4. Microcosting Simple Clinical Screening Scores Programmes
  • 5. <1>
  • 10. Background McElligott, Kinsella, & Roy (2006, 2009) 1 Patient
  • 11. Background McElligott, Kinsella, & Roy (2006, 2009) 1 Patient Birth at 24 weeks: the marginal case
  • 12. Background McElligott, Kinsella, & Roy (2006, 2009) 1 Patient Birth at 24 weeks: the marginal case 212 days in hospital
  • 13. Background McElligott, Kinsella, & Roy (2006, 2009) 1 Patient Birth at 24 weeks: the marginal case 212 days in hospital Q: How much did this cost?
  • 14. Data
  • 16. Data 176 variables 17 dierent antimicrobials,
  • 17. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’
  • 18. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’
  • 19. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days
  • 20. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
  • 21. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including
  • 22. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart)
  • 23. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart) 940 laboratory investigations
  • 24. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart) 940 laboratory investigations 2 x National Neonatal Transport Transfer
  • 25. Data 176 variables 17 dierent antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions 83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head, abdomen, heart) 940 laboratory investigations 2 x National Neonatal Transport Transfer Family’s Time, Equipment Maintenance, Refurbishment, and more
  • 26. Day 19 Fungal Sepsis, Day 202 Transfer to Crumlin RSV Vaccination
  • 27. Total Cost TC = €665,219.88 1 week: cost €5,167.50 Fixed cost: €26,608.00
  • 28. Conclusion Very precise data implies increased cost TC, MC substantially larger than UK, US estimates. So What? Vast Budget Implications
  • 29. /1
  • 30. 2
  • 31. Simple Clinical Scoring Kellett et al 2006, 2007, 2008 Simple tests give predictive scores which save time, effort, money, and, maybe, lives. Big Q: How much?
  • 32. Cost Effectiveness of Screening for Dementia Trepel Kinsella, 2008, Trepel’s PhD Simple Idea, very complex implementation
  • 33. Cochrane Review on Costing Studies What methods do people use when making ec. evaluations What numbers do they get, and why? A meta analysis (see poster)
  • 34. /2
  • 36. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
  • 37. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9 2. HRB Health Research Project grants, see http:// tinyurl.com/axv2hc
  • 38. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9 2. HRB Health Research Project grants, see http:// tinyurl.com/axv2hc 3. IRCHSS Post Graduate Scholarships, see http:// tinyurl.com/9fqug8
  • 39. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9 2. HRB Health Research Project grants, see http:// tinyurl.com/axv2hc 3. IRCHSS Post Graduate Scholarships, see http:// tinyurl.com/9fqug8 4. IRCSET Post Graduate Scholarships, see http:// tinyurl.com/7frgjk
  • 40. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9 2. HRB Health Research Project grants, see http:// tinyurl.com/axv2hc 3. IRCHSS Post Graduate Scholarships, see http:// tinyurl.com/9fqug8 4. IRCSET Post Graduate Scholarships, see http:// tinyurl.com/7frgjk 5. Private Funding opportunities also exist, please contact me directly for details.
  • 41. Ching? 1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9 2. HRB Health Research Project grants, see http:// tinyurl.com/axv2hc 3. IRCHSS Post Graduate Scholarships, see http:// tinyurl.com/9fqug8 4. IRCSET Post Graduate Scholarships, see http:// tinyurl.com/7frgjk 5. Private Funding opportunities also exist, please contact me directly for details.
  • 42. Questions I want to ask How much? Comparison/Evaluation of different methods Tricky data problems
  • 43. Health Economics Evidence Based Practice Stephen Kinsella KBS stephen.kinsella@ul.ie www.stephenkinsella.net