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Economicevaluation 08.Pptx

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An overview of economic evaluations in clinical reseach adapted from a NIH sponsored workshop.

An overview of economic evaluations in clinical reseach adapted from a NIH sponsored workshop.

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    Economicevaluation 08.Pptx Economicevaluation 08.Pptx Presentation Transcript

    • Economic Evaluation In Clinical Research
      • In 2006, US healthcare spending increased to a total of $2.1 trillion
        • Predicted growth of $4 trillion by 2020
      • Demand for healthcare resources is forcing policy makers to consider both the cost and the effectiveness of new treatments
      • Retrieved from: http://www.nchc.org/facts/cost.shtml
      • In 2007, NIH funded a total of $155 million in projects with an economic evaluation
        • 22% increase and denotes a trend towards funding for studies with an economic aim
      • Increased need for expertise to:
        • Conduct economic evaluations
        • Critically analyze published economic evaluations
        • Apply sound results to practice
      • A methodological approach that compares the consequences (outcomes) of two comparators and their associated costs
        • In clinical research, an economic evaluation compares the costs and consequences of an intervention compared to status quo
      • The determination of the cost of 1 intervention alone is an accounting exercise not an economic evaluation
        • Drummond et al, 1997
      • 4 Methods of Economic Evaluation
        • Cost Effectiveness Analysis (CEA)
        • Cost Minimization Analysis (CMA)
        • Cost-Utility Analysis (CUA)
        • Cost-Benefit Analysis (CBA)
      • CEA is the ratio of the cost of the intervention to a relevant measure of its effect
      • Cost-effectiveness is typically expressed as an incremental cost-effectiveness ratio (ICER), the ratio of change in costs to the change in effects
      • Results of CEA are reported in the form of cost (dollars) per health outcome
        • Cost per life saved
        • Cost per case prevented
        • Cost per point of blood pressure reduction
      • A method applied when comparing two interventions with equal efficacy and equal tolerability
        • there is no requirement to find a common efficacy denominator as would be the case when conducting a cost-effectiveness study
      • Results of CMA are reported as:
        • Cost per course of treatment
        • Cost per cure
      • CUA is to estimate the ratio between the cost of a health-related intervention and the benefit it produces in terms of the number of years lived in full health by the beneficiaries.
      • Allows the comparison of different health outcomes (such as prolongation of life, prevention of blindness or relief of suffering) by measuring them all in terms of a single unit — the quality-adjusted life-year (QALY).
      • When allocating scarce resources, those interventions that are expected to produce fewer QALYs for any given cost are given a lower priority.
      • Broadest form of economic evaluation, CBA examines the beneficial consequences of an intervention in monetary terms
        • This method measures the net change in resources expended (costs) and gained (benefits) by treatment
      • The results of CBA are reported as benefits (dollars) minus costs
      • Synthesizes large amounts of data
      • Standardized cost outcomes (cost/QALY)
      • Informs policy at the
        • Society (population, family, individual)
        • Purchasers (insurance providers, government)
        • Provider level (clinicians, hospitals systems)
    • Economic Evaluation: Challenges in Research Design and Measurement
      • Measuring Cost and Inflation over Time
        • Defining the relevant costs (societal, payer, and hospitals)
        • What data is available?
        • Meaningful Cost Measurements
          • Express dollars in terms of money that can purchase the same amount of (inflation)
          • Express dollars in a way that captures trade-offs and saving money (discounting)
      • Clinical Research
        • Lack of standardized costs to currency
          • Charges do not equate to costs
          • Cost to Charge Ratios
          • Micro-activity based costing
        • Standardizing all cost to a common year
          • Consider inflation and discounting