Rq Questions/ Exercises
Answers to Questions/Exercises
Chapter 1:
1.Example of Cost-Effectiveness Analysis (CEA):
Primary prevention of cardiovascular disease: cost-effectiveness comparison. Franco OH; der Kinderen AJ; De Laet C; Peeters A; Bonneux L. International Journal of Technology Assessment in Health Care. 2007 Winter; Vol. 23 (1), pp. 71-9.
Example of Cost-Benefit Analysis (CBA):
An employer-based cost-benefit analysis of a novel pharmacotherapy agent for smoking cessation. Jackson KC 2nd; Nahoopii R; Said Q; Dirani R; Brixner D. Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine. 2007 Apr; Vol. 49 (4), pp. 453-60.
The CEA compared 4 methods of preventing primary cardiovascular disease; smoking cessation, antihypertensives, aspirin, and statins. These options have very different effects, but one common outcome that was used in this comparison was ‘years of life saved’ by each strategy. Years of life saved is a natural clinical unit outcome – hence a CEA was used. The CBA explored options for smoking cessation, and ‘percent quit rate’ is an effectiveness measure that is often used to measure outcomes (which would produce a CEA ratio). Yet the further objective of this study was to measure costs to an employer for various smoking cessation options. Therefore, there was a dollar value estimated for the savings to the employee for each employee that quit smoking (e.g., lower absenteeism, lower insurance costs). These savings were subtracted from the costs of the options to determine a net benefit for each comparator. Since outcomes were measured in dollars, a CBA was conducted.
2.Many other countries provide health care coverage to its citizens via one centralized system funded by the government (taxes), so this one system has an incentive to determine the cost-effectiveness of pharmaceuticals and medical technology for the citizens of its country. Chapter 14 explains barriers to the use of health technology economic evaluations in the US.
3.Below are four of many possible questions:
- Should Drug X be restricted to specific patient populations (e.g. those who tried a less expensive drug that did not work for them, or those who have a contraindication or allergy to the less expensive medication)?
- Does the use of Drug X decrease other health care costs (e.g., hospitalizations, emergency department visits)?
- What is the added cost of using Drug X compared to the added clinical benefits due to Drug X?
- Would our institution see cost savings within 5 years due to the implementation of a pharmacist-run anticoagulation clinic?
4.For many diseases, if productivity costs (indirect costs) are included in cost-of-illness or burden of illness estimates, they are lower than medical costs (direct costs). For example, indirect costs were about 40% of the total costs of asthma [Weiss KB, Sullivan SD, Lyttle CS. Trends in the cost of illness for asthma in the United States, 1985-1994. The Journal of Allergy And Clinical Immunology 2000: Vol. 106 (3), p. 493-999.]. For endometriosis, productivity costs were about one-third of total costs [Endometriosis: cost estimates and methodological perspective. Simoens S; Hummelshoj L; D'Hooghe T Human Reproduction Update 2007 Jul-Aug; Vol. 13 (4), pp. 395-404]. For other diseases, such as HIV, indirect costs far outweigh direct medical costs. [The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: evidence of continuing racial and ethnic differences. Hutchinson AB; Farnham PG; Dean HD; Ekwueme DU; del Rio C; Kamimoto L; Kellerman SE Journal Of Acquired Immune Deficiency Syndromes 2006 Dec 1; Vol. 43 (4), pp. 451-7.]