Economicevaluation 08.Pptx

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

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Economicevaluation 08.Pptx

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

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