Results Of Cost-utility Analysis Research Articles

Comparison of Caregiver and General Population Preferences for Dependency-Related Health States.

We assess whether the preferences regarding dependency-related health states as stated by informal caregivers are aligned with those expressed by the general population. The preferences of a sample of 139 Spanish informal caregivers of dependent patients are compared with those obtained via a sample of 312 persons, also from the Spanish general population. We assess 24 dependency states extracted from the DEP-6D using the time trade-off method. Descriptive statistics and regression methods are used to explore differences between the two samples. Mean difference tests establish that, for all but one of the 24 states, there are no significant differences between the samples. The estimated mean values ranged from - 0.64 to 0.60 for the caregiver sample and from - 0.60 to 0.65 for the general population sample, with a correlation of 0.96. On average, the classification of states as better or worse than dead matched in both samples (except for one state). Regression models also show that sample type does not have a significant average impact. After we introduce interaction effects, only the most severe level of two dimensions, cognitive problems and housework, result in significant differences-with the caregiver sample reporting higher values for the former, and lower values for the latter. Caregivers and the general population exhibit quite similar preferences concerning dependency-related health states. This suggests that the results of cost-utility analyses, and the resource allocation decisions based on them, would likewise not be significantly affected by the preferences used to generate the weighting algorithm.

Methodological challenges surrounding QALY estimation for paediatric economic evaluation

Cost-utility analysis remains the preferred form of economic evaluation for health technology assessment, pricing and reimbursement authorities in several countries. The results of cost-utility analyses are commonly expressed in terms of incremental cost per quality-adjusted life year (QALY) gained where the QALY combines length of life and health-related quality of life in a single metric. This commentary provides an overview of key methodological challenges surrounding QALY estimation for paediatric economic evaluation. These challenges include issues surrounding the relevant attributes to incorporate into measurement instruments, appropriate respondents for the measurement and valuation tasks, perspectives adopted when completing valuation tasks, potential sources of bias in the description and valuation processes, and the paucity of psychometric evidence for existing measures. In addition, the commentary considers methodological challenges raised by research aimed at assessing whether a QALY gain by a child should be valued equally to a QALY gain by an adult.

Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis?

ObjectivesTo experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. MethodsA new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. ResultsAlthough both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. ConclusionsMCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.

PNS40 Economic Evaluation of New Models of Care: Does the Decision Change between Cost-Utility Analysis and MULTI-Criteria Decision Analysis?

Abstract Objectives To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. Methods A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. Results Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. Conclusions MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.

PMU29 REAL-WORLD IMPACT OF DISEASE ON FUNCTIONING AND ACTIVITY: A CROSS-SECTIONAL STUDY OF THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

Economic evaluations conducted to inform healthcare resource allocation often rely on quality-adjusted life years (QALYs) to measure therapeutic benefit. However, QALYs, with underlying health utilities estimated using the EQ5D or SF36, may fail to capture the full impact of disease as they do not robustly quantify physical and cognitive limitations. We explored how well-being and heath utility can differ across diseases. This study examined 8 conditions: arthritis, asthma, cancer, depression, diabetes, heart disease, lung disease, and stroke. Health utilities for each condition were obtained from published literature. Other measures of disease burden were estimated from the National Health and Nutrition Examination Survey (NHANES). The 2015-2016 physical functioning (PF) and physical activity (PA) questionnaires were used to measure PF and PA while the 2013-2014 Digit Symbol Substitution Test was used to measure cognitive functioning. Group rankings by these measures were compared to rankings by health utility. Health utilities were lowest for depression (0.44) and stroke (0.76), and highest for those with cancer (0.81) and diabetes (0.79). Physical functioning was worst (higher score) among those with stroke (28.2), lung disease (27.3), and depression (27.1) and best for cancer (24.4) and diabetes (24.6). Physical activity was most impacted by heart disease (27.3) and lung disease (29.0), and least impacted by depression (40.7). Cognitive functioning was worst (41.6) in stroke and best (52.0) in asthma. Differences in rankings of disease severity by utilities and by well-being metrics demonstrate that utilities, and results of cost-utility analyses that use them, might be biased against treatments for certain conditions. As patient preferences for clinical outcomes vary, the full burden of disease should be considered in evaluations. Restricting access to treatments based on an incomplete estimate of burden could lead to misallocation of resources and a withholding of therapies that patients find valuable.

Economic evaluation on breast cancer screening in mainland China: a systematic review

Objective: To gather available evidence related to the economic evaluation on breast cancer screening in mainland China and to provide reference for further research. Methods: A systematic review was conducted to identify articles in PubMed and three Chinese databases (CNKI, Wanfang and VIP) during 1995-2015. Data related to descriptive characteristics, rates on participation and detection for population-based studies, methods for model-based studies, types of economic evaluation and results, were extracted. A Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the reporting quality of included studies. Results: Of the 356 records searched in the databases, 13 studies (all published between 2012 and 2015) were included in the current paper involving 11 population-based studies and 3 model-based evaluations (1 study using both methods). Age of the participants who started to be engaged in the screening program ranged from 18 to 45 years old, but terminated at the age of 59 years or older. The screening modalities included single-used clinical breast examination, mammography and ultrasound or combined applications. Study persepectives were described in 7 studies, with 5 from the healthcare providers, and 2 from societal angles. Only 5 studies discounted cost or effectiveness. Out of 11 papers, 9 showed the results on cost-effectiveness analysis (CEA) that reporting the cost per breast cancer detection, with median as 145.0 thousand Chinese Yuan (CNY), ranging from 49.7 thousand to 2 293.0 thousand CNY. From 4 papers with results of cost-utility analysis (CUA), the cost per quality adjusted life year (QALY) gained or cost per disability adjusted life year (DALY) averted, were evaluated. The incremental cost-effectiveness ratio (ICER) was from 2.9 thousand to 270.7 thousand CNY (GDP per capita of China was CNY 49.3 thousand in 2015). In 13 studies, the quality of reporting varied, with an average score of 14.5 (range: 9.5-21.0). In the domains of study perspective, discounting, ICER and uncertainty, all the scores of equalities were relatively levels. Conclusions: Currently, evidence on economic evaluation of breast cancer screening in mainland China remained limited and weakly comparable, particularly model-based studies. Comprehensive analysis from societal perspective and QALY or DALY related cost-utility analysis should be implemented.

Cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy

We conducted a cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease (COPD) compared with usual care. A randomized controlled trial was carried out over four months with 45 patients treated with long-term oxygen therapy, 24 in the telehealth group (TG) and 21 in the control group (CG). The analysis took into account whether the severity of comorbidity (defined as the presence of additional chronic diseases co-occurring with COPD) was associated with differences in costs and/or quality-adjusted life years (QALYs). Results of cost-utility analysis were expressed in terms of the incremental cost-effectiveness ratio (ICER). The average total cost was €2300 for the TG and €1103 for the CG, and the average QALY gain was 0.0059 for the TG and 0.0006 for the CG (resulting an ICER of 223,726 €/QALY). For patients without comorbidity, the average total cost was €855 for the TG and €1354 for the CG, and the average QALY gain was 0.0288 for the TG and 0.0082 for the CG (resulting in the telehealth programme being the dominant strategy). For patients with comorbidity, the average total cost was €2782 for the TG and €949 for the CG, and the average QALY gain was −0.0017 for the TG and −0.0041 for the CG (resulting an ICER of 754,592 €/QALY). The telehealth programme may not have been cost-effective compared to usual care, although it could be considered cost-effective for patients without comorbidity.

Transferability of results of cost utility analyses for biologicals in inflammatory conditions for Central and Eastern European countries.

Several Central and Eastern European (CEE) countries require cost-utility analyses (CUAs) to support reimbursement formulary listing. However, CUAs informed by local evidence are often unavailable, and the cost-effectiveness of the several currently reimbursed biologicals is unclear. To estimate the cost-effectiveness as multiples of per capita GDP/quality adjusted life years (QALY) of four biologicals (infliximab, etanercept, adalimumab, golimumab) currently reimbursed in six CEE countries in six inflammatory rheumatoid and bowel disease conditions. Systematic literature review of published cost-utility analyses in the selected conditions, using the United Kingdom (UK) as reference country and with study selection criteria set to optimize the transfer of results to the CEEs. Prices in each CEE country were pro-rated against UK prices using purchasing power parity (PPP)-adjusted per capita GDP, and local GDP per capita/QALY ratios estimated. Central and Eastern European countries list prices were 144-333% higher than pro rata prices. Out of 85 CUAs identified by previous systematic literature reviews, 15 were selected as a convenience sample for estimating the cost-effectiveness of biologicals in the CEE countries in terms of per capita GDP/QALY. Per capita GDP/QALY values varied from 0.42 to 6.4 across countries and conditions (Bulgaria: 0.97-6.38; Czech Republic: 0.42-2.76; Hungary: 0.54-3.54; Poland: 0.59-3.90; Romania: 0.77-5.07; Slovakia: 0.55-3.61). While results must be interpreted with caution, calculating pro rata (cost-effective) prices and per capita GDP/QALY ratios based on CUAs can aid reimbursement decision-making in the absence of analyses using local data.

PMH46 - Cost-Utility Analyses of Cognitive-Behavioral Therapy for Major Depressive Disorder – A Systematic Review

Major depressive disorder (MDD) causes a massive health and economic burden for societies worldwide. Cognitive behavioural therapy (CBT) is an inherent part of the treatment of MDD and is recommended for children, adolescents and adults. Cost-Utility-Analysis (CUA) is an important instrument to support decision-making on resource allocation and health policy as it permits the comparison of interventions for different diseases. The objective of our study was to systematically review CUAs related to CBT in the treatment of patients suffering from MDD. We conducted a systematic literature search in MEDLINE, EMBASE, PsycINFO and NHSEED. We included all original studies reporting CUA of CBT for patients suffering from MDD. Cost data were inflated to the year 2011 and converted into US-$ using purchasing power parities (US-$ PPP) to ensure comparability of the data. Quality assessment of the studies was performed by means of a standardised quality checklist. We identified 22 CUAs. The methodological quality was fair. Two studies considered a lifetime horizon. The mean time horizon of the remaining studies was 19.2 months (SD = 12.6). In most instances individual and group CBT as well as CBT for maintenance showed acceptable cost-utility ratios (ICER < 50.000 US-$-PPP / QALY). The results of CUAs of CBT provided for children and adolescents or by computer were inconsistent. In comparison to medication CBT tends to be more cost effective as stand-alone therapy and in combination with medication. Individual and group CBT is a cost effective treatment for MDD. Further research to determine the cost effectiveness of computerized CBT and of CBT for specific populations like children, adolescents or the elderly is required. Furthermore there is a need for long term evidence of cost effectiveness of CBT.

The Impact of the Pharmaceutical Pricing System on Cost-Effectiveness Results: Finnish Analysis

In Finland, the drug retail prices are determined with a regressive pharmaceutical pricing scheme (PPS) that leads to higher absolute sales margins for products with higher wholesale prices. At the same time low-priced products are sold at prices below the true costs of drug delivery. Despite these characteristics retail prices are used to represent all drug costs in health economic evaluations that are required before societal reimbursement of new drugs can be granted. We assessed the impact of PPS induced cost differences on the results of cost-utility analyses in hypothetical examples. The examples show that the Finnish PPS worsens the ICERs obtained for more expensive pharmaceuticals. The Finnish PPS is problematic when the aim is to provide Finnish patients with optimal, cost-effective treatments. In its current form, the PPS discourages innovation and comparability of results with other settings, and may prevent reimbursement of otherwise cost-effective treatments.

The impact of using different tariffs to value EQ-5D health state descriptions: an example from a study of acute cough/lower respiratory tract infections in seven countries

When using the EQ-5D in European cross-national studies, there is no consensus over whether the European value set (EVS), country specific value sets (CVS) or UK value set (UKVS) should be used. Data on health outcomes were collected in 7 countries. EQ-5D index scores were generated for each country using all three value sets. QALYs gained over 4 weeks based on EQ-5D scores were also generated in order to investigate the implications for cost-utility analysis. EQ-5D scores obtained using the EVS were similar to values obtained using the CVS and UKVS in all countries. CVS-based EQ-5D scores were on average associated with a smaller baseline-to-week 4 change/improvement in all countries (except in Wales and Belgium) while UKVS-based EQ-5D scores showed the largest improvement over the same period for every country. With regards to cost-utility analysis, the results suggest that in most countries (with the exception of Belgium and Finland), using different tariffs to value EQ-5D would not have made a difference to the decisions based on the results of cost-utility analysis.

Effect of Health-Related Quality-Of-Life Instrument and Quality-Adjusted Life Year Calculation Method on the Number of Life Years Gained in the Critical Care Setting

Objectives Health-related quality of life (HRQoL) and quality-adjusted life-years (QALYs) gained are basic elements in the cost-utility evaluations of health care. Different HRQoL instruments produce different scores for the same patient, and thus also a different number of QALYs. We examined the effect of these factors on the number of QALYs gained and the cost per QALY in the critical care setting. Methods In 937 patients having been treated in the critical care setting in the Helsinki University Central Hospital the HRQoL scores were measured by the EQ-5D and 15D 6 and 12 months after start of treatment, and QALYs were calculated using four different sets of assumptions regarding recovery from disease. Results The mean number of QALYs gained during the first year after treatment ranged from 0.178 ± 0.206 to 0.550 ± 0.508 and the consequent cost per QALY from €38,405 to €118,668 depending on HRQoL instrument and assumptions used in the calculations regarding recovery from disease. Conclusions The HRQoL instrument and the assumptions employed regarding recovery from disease have a great influence on the results of cost-utility analyses and should, therefore, be explicitly described in studies reporting QALYs. Furthermore, a common consensus on which calculation method should be used within critical care would be urgently needed.

Comparison of utility measures and their relationship with other health status measures in 1041 patients with rheumatoid arthritis

ObjectivesThe aim of this study was to compare three health utility instruments (15D, EQ-5D, SF-6D) and a rating scale for health (EQ-Visual Analogue Scale (VAS)) and to investigate their relationship...

Pharmacoeconomics of the New Antidepressants and Antipsychotics

This review summarizes results of cost-utility analyses done with newer versus older antidepressants as well as atypical versus conventional/typical neuroleptics/antipsychotics. Following descriptions of the methodological principles, the currently available studies (simulation models) are presented and discussed critically. It can be stated that the economic value of different antidepressants and the atypical neuroleptics can not be decided definitively at the present time due to methodological reasons (e. g. lacking of randomized prospective studies). Increased quality of life of patients and their family seems true for the newer psychotropics, measurement is difficult, however, and a challenge for social and ethical discussions.

Assigning values to intermediate health states for cost-utility analysis: theory and practice.

Cost-utility analysis (CUA) was developed to guide the allocation of health care resources under a budget constraint. As the generally stated goal of CUA is to maximize aggregate health benefits, the philosophical underpinning of this method is classic utilitarianism. Utilitarianism has been criticized as a basis for social choice because of its emphasis on the net sum of benefits without regard to the distribution of benefits. For example, it has been argued that absolute priority should be given to the worst off when making social choices affecting basic needs. Application of classic utilitarianism requires use of strength-of-preference utilities, assessed under conditions of certainty, to assign quality-adjustment factors to intermediate health states. The two methods commonly used to measure strength-of-preference utility, categorical scaling and time tradeoff, produce rankings that systematically give priority to those who are better off. Alternatively, von Neumann-Morgenstern utilities, assessed under conditions of uncertainty, could be used to assign values to intermediate health states. The theoretical basis for this would be Harsanyi's proposal that social choice be made under the hypothetical assumption that one had an equal chance of being anyone in society. If this proposal is accepted, as well as the expected-utility axioms applied to both individual choice and social choice, the preferred societal arrangement is that with the highest expected von Neumann-Morgenstern utility. In the presence of risk aversion, this will give some priority to the worst-off relative to classic utilitarianism. Another approach is to raise the values obtained by time-tradeoff assessments to a power a between 0 and 1. This would explicitly give priority to the worst off, with the degree of priority increasing as a decreases. Results could be presented over a range of a. The results of CUA would then provide useful information to those holding a range of philosophical points of view.