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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