Advanced Concepts in Cost-Effectiveness and Cost-Benefit Analysis, Hs426f

Advanced Concepts in Cost-Effectiveness and Cost-Benefit Analysis, HS426f

Syllabus – Spring 2015 (Updated 25Feb 2015) Draft

Prof. Donald S. Shepard and Assistant Prof. Wu Zeng

Donald S. Shepard, PhD.

Heller School room 275, MS 035 Brandeis University,

Waltham, MA 02454-9110 E-mail: , Tel: 1-781-736-3975

Web:

Wu Zeng, MD, PhD, MS

Heller School, Rm 246

email:

Guest lecturer and teaching assistant: Yara Halasa, DDS, MS

Heller School, Rm 273

email: ; 1-781-736-3831

Executive Assistant: Clare L. Hurley, : 1-781-736-3983

Schedule: Wednesday evenings, 6:00 pm – 8:50 pm

Schneider Room G-4, Spring semester, Block II

Overall Objective: This module provides students with advanced techniques to conduct or critically review cost-effectiveness and cost-benefit studies, both in the US and internationally. Students will learn how to present a research question, design a study, obtain and analyze relevant data, and analyze the results. The module will examine theoretical underpinnings and operational techniques, illustrated by one or more real-world applications. Several of the applications are based on the instructors’ own research, permitting behind-the-scenes discussions about tradeoffs, challenges, and solutions in design, data collection, and analysis. While many of the applications will be from the health sector, students can apply the techniques to any subject of interest. As a prerequisite to this advanced course, students must have completed a prior course of at least one module on cost-benefit or cost-effectiveness analysis (with any type of application) or equivalent prior experience or study, such as “Cost-Effectiveness and Cost-Benefit Analysis” (Prof. Shepard, HS 422f).

Approach: Real world, relevant examples of cost-benefit and cost-effectiveness analyses, drawn from both the United States and internationally, will be used to reinforce the lectures. To reinforce the techniques, students will be asked to complete several homework assignments over the course and to write a final paper. Yara Halasa, DDS, MS will also contribute to the course.

Evaluation:Students will be evaluated primarily (75% weight) on a written paper and secondarily on required homework exercises (25% weight). Students may collaborate on homework, but each student must submit an individual answer and must answer the qualitative questions in his or her own words.

The written paper will require students to apply methods of cost-effectiveness or cost-benefit analysis to a problem or question of the student’s choice. The analysis should be based on real data where available, supplemented as needed with expert assumptions, discussed for plausibility. The paper may be set in any country and address any environmental, social or health program, policy, or system-level question. Students are encouraged to write a joint paper with one or two classmates, but may work individually if they prefer. The paper should include a title page with the names of author(s), an abstract, references, and at least one table or figure. References should follow any standard style of the authors' choice. The text should be double spaced with 1-inch margins and 12-point type. Tables and figures may use any desired spacing and consistent format. The paper should be carefully checked for spelling, grammar, and consistency of style. The maximum length depends on the group size--10 pages for a single author, 15 pages for two authors, and 20 pages for three authors (excluding title page, abstract, preface, table of contents, references, and any appendix materials).

Students may build on a prior paper, but the paper for this module must contain substantial advances or extensions. Papers will be judged on the strength of the data and analysis presented, as well as the clarity and organization of the paper. To allow time for grading and submitting grades, the Final Project Paper for Module II is due Monday April 27th, at 11:55 pm for all students.

Disability: Any student with a documented disability on record at Brandeis University who wishes to have a reasonable accommodation made for him or her in this class should contact the instructor immediately.

Textbook:

Michael F. Drummond, Mark J. Sculpher, George W. Torrance, Bernie J. O'Brien, Greg L. Stoddart. Methods for the Economic Evaluation of Health Care Programmes, Third Edition. New York: Oxford University Press. 2005.

Session 1. (March 11, 2015) Economic modeling in cost-effectiveness and cost benefit analyses

Objective: This session discusses economic modeling in cost-benefit, cost-effectiveness, cost-utility analysis and their use in policy development.

Thoughts to consider for session 1:
(See, Brown et al.: "The economic cost of domestic hunger")

To estimate the economic burden of hunger (food insecurity) on depression, what kinds of data did Brown et al. use, and what were their strengths and limitations?
To estimate the economic burden of hunger (food insecurity) on learning, what kinds of data did Brown et al. use, and what were the strengths and limitations?
What factors required that education effects be analyzed differently from health effects, and did the authors’ address those factors?
Did the study try to distinguish costs associated with hunger versus costs caused by hunger, and if so, how well?

Required readings:

Brown JL, Shepard DS, Martin T, Orwat J. The economic cost of domestic hunger: Estimated annual burden to the United States. Gaithersburg, MD: Sodexho Foundation, 2007.
Press release, 2011, Hunger in America

Lab session 1:
Estimating the cost of hunger in America

Homework:
No homework assignment for Class l

Supplemental readings:

Shepard DS, Setren E, Cooper D: Hunger in America, 2011. (full updated report)

Session 2: (March 18,2015) Costing of programs and interventions

Objective: This session covers the design of an economic evaluation and techniques for assessing the costs of a program. Topics include the collection of program data, the need for triangulation to address possible inconsistencies, the distinction between economic and accounting costs, and applications from the authors’ research from the Alcohol and Drug Services Study and the Treatment Cost Assessment Tool.

Thoughts to consider for session 2:

(Re: Shepard, et al.: "The ADSS Cost Study")

How does this paper attribute resources (time, etc.) to the one activity that is the focus under study (e.g., treatment in the outpatient modality), and what were the strengths and limitations of the approach?
How does this paper treat capital costs, and what were the strengths and limitations of the approach?
What perspective did the study use, why, and what would have changed if other perspectives had been considered.
In accounting for time, how does the analysis attribute the cost of unallocated time (e.g. idle time, sick time)?

Required readings:

Shepard, D.S., Beaston-Blaakman, A., and Horgan, C. The ADSS Cost Study: Costs of Substance Abuse Treatment in the Specialty Sector.
Flynn, P.M., Broome, K.M., Beaston-Blaakman, A., Knight, D.K., Horgan, C.M., Shepard, D.S. Treatment Cost Analysis Tool (TCAT) for estimating costs of outpatient treatment services. Drug and Alcohol Dependence 100:47-53, 2009

Lab session 2:

Lab #2 ADSS study in cost-estimation

Homework #1:

Homework #1 Scenario and questions for ADSS Study in cost estimation

Supplemental readings:

No supplemental readings for class 2.

Session 3: (March 25, 2015) Contingent valuation and willingness-to-pay (Guest Lecturer Yara Halasa, DDS, MS)

Objective: This session addresses elicitation of stated willingness to pay for health products or improvements, discussing both the conceptual and practical strengths and limitations of the technique.

Thoughts to consider for session 3:

How does willingness to pay depend on the initial value, and how did this study minimize this artifact?
How does stated willingness to pay compare to values from actual decisions?

Required readings:

Drummond Chapter 7, part 7.3 "What might we mean by willingness-to-pay"
Halasa, Y.A.; Shepard, D.S., Wittenberg, E.; Fonseca, D.M.; Farajollahi, A.; Healy, S.; Gaugler, R.; Strickman, D.; Clark, G.G. Willingness-to-pay for an area-wide integrated pest management program to control the Asian tiger mosquito in New Jersey. Journal of the American Mosquito Control Association 28(3):225–236, 2012.
Halasa, Y.A., Shepard, D.S., Fonseca, D.M., Farajollahi, A., Healy, S., Gaugler, R., Bartlett-Healy, K., Strickman, D.A., Clark, G.G. 2014. Quantifying the impact of mosquitoes on quality of life and enjoyment of yard and porch activities in New Jersey. PLoS One, 9(3):e89221. Available at:
Shepard, D.S., Halasa, Y.A., Fonseca, D.M., Farajollahi, A., Healy, S., Gaugler, R., Bartlett-Healy, K., Strickman, D.A., Clark, G.G. 2014. Economic Evaluation of an Area-wide Integrated Pest Management Program to Control the Asian Tiger Mosquito in New Jersey. PLoS One. 9(10): e111014. doi:10.1371/journal.pone.0111014. Available at:

Lab session 3:
Willingness-to-pay exercise

Homework:
No homework assignment for class 3

Supplemental readings:.

No supplemental readings for class 3

Session 4: (April 1, 2015) Monte Carlo modeling and sensitivity analyses

Objective: This session addresses the development and use of simple mathematical models to address multiple sources of information, and using them for sensitivity analyses. It will apply these concepts in estimating the cost of dengue in 8 endemic countries.
Thoughts to consider for session 4:

How did the authors address uncertainties in numbers of reported cases and cost per case? How would the expansion factor be incorporated?
What, if any other factors might be considered in the uncertainty? How were the observational data used to establish effectiveness of the annual larvidicing campaigns, and what were the strengths and limitations?
Official reporting of dengue, like that of most “reportable” conditions, is thought to understate the real number of cases. How would this factor affect the findings? See Undurraga et al., 2013, excerpt (abstract, relevant part of text, and figure).
From the brief description, how comprehensive was the treatment of costs, and what elements may have been inadequately counted?

Required readings:

Suaya, J.A.; Shepard, D.S.; Chang, M-S.; Caram, M.; Hoyer, S.; Socheat, D.; Chantha, N.; Nathan, M.B. Cost-effectiveness of annual targeted larviciding campaigns in Cambodia against the dengue vector Aedes aegypti. Tropical Medicine and International Health 12(9):1026–1036, 2007.
Suaya, J. A., Shepard, D.S.et al.Cost of dengue cases in eight countries in the Americas and Asia: a prospective study. American Journal of Tropical Medicine and Hygiene 80(5):846–855, 2009.
Undurraga E, Halasa YA, Shepard DS. Use of expansion factors to estimate the burden of dengue in Southeast Asia: a systematic analysis. PLoS Neglected Tropical Diseases 7(2): e2056, 2013. (doi:10.1371/journal.pntd.0002056) [focus on excerpt]

Lab session 4:
Exercise with Monte Carlo simulation software

MCSim – Monte Carlo Simulation (Excel Add-in)

Monte Carlo simulation stata02 do file

Homework #2:

HOMEWORK #2 Estimation of costs and cases of Dengue with Monte Carlo modeling assignment

Session 5: (April 8, 2015) Cost-effectiveness acceptability curves and modeling quality of life

Objective: This session addresses cost-effectiveness acceptability curves, and policy modeling related to quality of life. It reviews widely used scales such as the WHO Quality of Life Scale (WHO QOL), the SF 12, and the SF 36, the WHO Disability assessment schedule (WHODAS II), and the tradeoff among widely used techniques for assessing disability weights. Techniques include the visual analogue scale (VAS), person tradeoff, and time tradeoff (TTO). Behind these scales are real tradeoffs faced by those living with an acute or chronic condition, as well as tradeoffs by policy makers.

Thoughts to consider for session 5:

In the modeling study on cost-effectiveness of anti-retroviral therapy (ART), how did the authors assess the quality of life of patients receiving ART compared to the counterfactual of no ART?
How are externalities considered when an illness affects not only the patient, but other family members or others generally?
How might this concept affect costs of such as a parent caring for a young child with an acute febrile illness, a family member caring for an elder with dementia, or a citizen at risk of encountering a motorist under the influence of alcohol.

Required readings:

Fenwick E, Byford S. A guide to cost-effectiveness acceptability curves. British Journal ofPsychiatry (2005) 187:106-108.
Drummond, Chapter 8, “Economic evaluation using patient-level data”

Lab session 5:

No lab session for class 5.

Homework:
No homework assignment for Class 5.

Supplemental readings:
No supplemental readings for Class 5.

[Note: No class on Wed. April 15, 2015 due to spring break]

Session 6: (April 22, 2015) Disease modeling

Objective: Develop basic understanding of Markov models and where they are appropriate.

Thoughts to consider for session 6:

In the paper on Progresa (assigned in HS 422f), how was the Markov model used to extend beyond the one year of observational data in the randomized trial?
In the paper by Tyo et al, how was the Markov model used to estimate the benefits to children (the age group receiving vaccinations) and elders (the age group receiving substantial favorable externalities).

Required readings:

Drummond, Chapter 9, “Economic evaluation using decision analytic modeling”
Tyo et al.Cost-effectiveness of conjugate pneumococcal vaccination in Singapore: Comparing estimates for 7-valent, 10-valent, and 13-valent vaccines. Vaccine 29 (2011) 6686– 6694.

Lab session 6:
Markov modeling.

Tables for cost-effectiveness of conjugate pneumococcal vaccination in Singapore

Markov add-in

Lab Markov Progresa 2012v02

Homework:
No homework assignment for class 6

Supplemental readings:

Behrman J, Sengupta, P, Todd P. Progressing through Progresa: An impact assessment of a school subsidy experiment. Philadelphia, PA: University of Pennsylvania, 2001. [Note: Read primarily pp. 1-5 and 11-21 and associated tables and figures.

Session 7: (April 29, 2015) Real world implementation and modeling AIDS (Guest Lecturer, Wu Zeng, MD, PhD, MS)

Objective: This session addresses real world implementation of a program using two tools. The first is the idea of the Estimated Community Model, indicating how an intervention would be adapted from the context of a clinical trial to the real world. The second tool, Spectrum, is for modeling the AIDS epidemic and other diseases in resource-limited settings, and how these tools can be used in policy applications. We will use sample data to simulate the AIDS epidemic with Spectrum software.
Thoughts to consider for session 7:

How can expert opinion be used to develop an Estimated Community Model?How can we project the cost of the Estimated Community Model, since it has not been implemented already?
As an effective AIDS vaccine is not developed yet, what are the assumptions on effectiveness of the AIDS vaccine?
How is the efficacy of the AIDS vaccine transformed into the number of infections averted in the model?
Considering the cost of AIDS vaccination, how would recommended vaccination strategies differ between countries with concentrated epidemics and those with generalized epidemics?

Required readings:

Beaston-Blaakman, A.; Shepard, D.S.; Stone, N.; Shevitz, A.H. Cost-effectiveness of clinical

interventions for AIDS wasting. AIDS Care 19(8):996-1001, 2007.

Stover J, Bollinger L, et al. The Impact of an AIDS Vaccine In Developing Countries: A New Model And Initial Results
Bollinger L, Stover John. HIV Vaccine -- A Model for Examining the Effects of an AIDS Vaccine

Lab session 7:
No lab session for class 7.

Homework:
No homework assignment for class 7

Supplemental readings:
No supplemental readings for class 7.