Economic Evaluation in D & I Research Tzeyu Michaud, PhD Department of Health Promotion, Social, & Behavioral Health UNMC Overview What is economic evaluations?
Why conduct economic evaluations? Review of economic evaluations How to start an economic evaluation? Return on Investment Example
Q & A session What is Economic Evaluations? A tool to make comparisons of alternative options in terms of their costs and consequences It provides a systematic way to identify, measure, value, and compare the costs and consequences of various programs, policies, or interventions
It is comparative Why conduct economic evaluations? To inform the decisions of various health care systems about which health care interventions to fund from available resource To evaluate whether an intervention are worth implementation and To evaluate whether the benefits from already implemented interventions have been worth the
costs To ensure society can receive a good return on its investment in public health Compare two or more alternatives? Healthcare Evaluation Are both costs and outcomes measured? No No Yes Examine outcomes only
Examines costs only outcome description Cost description cost-outcome description Full economic evaluation Costeffectiveness analysis Efficacy or Cost-benefit effectiveness Cost analysis Yes
analysis evaluation Cost-utility analysis Source: Drummond et al. Methods for the Economic Evaluation of Health Care Programmes, 2005. Type of (full) Economic Evaluations Costs Effects Evaluation Question Costeffectiveness analysis Monetary unit
Natural units (lifeyears gained, disease events prevented) Comparison of intervention with same objectives Cost-utility analysis Monetary unit Utility, QALYs, or DALYs Comparison of intervention with different objectives
Cost-benefit analysis Monetary unit Monetary unit Are the benefits worth the costs? Monetary unit Effects are not measured (they are considered to be equal)
Least-cost comparison of programs with the same outcomes Method Costminimization analysis Adapted from WHO methodological approaches for CE and CUA of injury prevention measures, 2011. How to Start an Economic Evaluation? Intervention Costs Fixed costs Equipment/ technology Facilities (e.g. office space, or intervention space)
Other Variable costs Personnel Training Administrative/ operating Other (e.g. supplies) Which costs are counted? cost components/perspect ive Societal Healthcare sector
Payers paid by payers Yes Yes Yes out-of-pocket Yes Yes No
Informal healthcare (e.g. transportation, unpaid caregiving time, or patient time) Yes No No Non-healthcare (e.g. loss of productivity Yes No No
Formal healthcare Adapted from Cost-Effectiveness in Health and Medicine, 2017. Source of Cost Data Collection Administrative data base Survey for providers and beneficiaries Observational studies
Expert panel Published price list (e.g. average wholesale price) Published literature Others Return on Investment ROI = $ Gained (- $ Cost of
Investment) $ Costs of Investment Depends on what to include in gained and costs. Weight and Win: a 12-month community weight loss program Implementation costs- 2.82 millions Program evaluation
Reach: 33,656 person who were overweight or obese (African American were over-represented) Effectiveness : 47% and 34% of participants loss 3% and 5% of initial body weight, respectively Cost per clinically meaningful weight loss for African Americans ($258/ 3%loss; $336/5%loss) was lower than that for Hispanics ($319; $431) and Caucasians($314; A state transition Markov model to project lifetime economic outcome and the degree of disease averted, compared with no intervention The program was predicted to avert (with a corresponding estimated medical costs saved of) 78 cases of coronary heart disease ($28 million) 9 cases of strokes ($971,832)
92 cases of diabetes ($24 million) 3 cases of breast cancer ($483,259) 1 case of colorectal cancer ($357,022) The estimated medical costs saved per participant was $1,403 ($1,077 of African American men and $1,532 of Hispanic men), and the ROI was $16.7 ($12.8 for African American men and $18.3 Cost-Effectiveness Analysis Cost Components Summary Economic evaluation is comparative
Plan ahead (cost data, alternative comparison, perspective, outcomes measured) ASK for help! Resource Cost-Effectiveness in Health and Medicine, Gold et al., 1996 Methods for the Economic Evaluation of Health Care Programmes, Drummond et al., 2015
Guidelines for reporting economic evaluations for health interventions. http://www.equator-network.org/wp-content/upload s/2013/04/Revised-CHEERS-Checklist-Oct13.pdf Tufts CEA registry. http://healtheconomics.tuftsmedicalcenter.org/cear 4/SearchingtheCEARegistry/SearchtheCEARegistry.a spx Thank You [email protected]
Reported Outcomes Cost-Effectiveness Analysis Relevant when alternative options have different costs and health consequences Costs are valued in monetary terms (e.g., US$) Benefits are valued in terms of clinical outcomes (e.g., cases prevented or cured, lives saved, years of life gained, qualityadjusted life years gained)
Results reported as a cost-effectiveness ratio Cost-Effectiveness Ratio Net increase in health care costs Net gain in health effects quality-adjusted life years cost-utility analysis Example 1 Example 3
