1
Q
CEA
A
- Analysis where inputs are measured in monetary values and outcomes in natural health units that indicate an improvement in health, such as cures, lives saved, and decreased blood pressure
- *Most prevalent pharmacoeconomic analysis found in pharmacy literature
2
Q
CEA Advantages
A
- Health units are common outcomes routinely measured in clinical trials and outcomes studies, therefore familiar and acceptable to practitioners
- Outcomes do not need to be converted to monetary values (as in CBA)
3
Q
CEA Disadvantages
A
- Alternatives being compared must be measured in same clinical outcome units
- Only one outcome can be compared at a time
- Difficult to consider intangible costs (pain, nausea) in CEA
4
Q
Total Cost =
A
Cost/patient * # of patients
5
Q
CCA
A
- Cost Consequence Analysis
- Analysis summarized in final table
- Cost-effectiveness isn’t determined by a single value, but by a summary for each component provided
6
Q
Calculate CER
A
- Average CER would tell you how much it costs to achieve a unit of outcome with each treatment
- NOT comparative cost
7
Q
ICER
A
- Incremental Cost-Effectiveness Ratio
- Estimate how much it will cost to achieve one more unit of benefit beyond what standard/baseline provides
- Interpretation: To increase the number of SFD, need additional $___ for each SFD above ___
- Tells you how much cost is increased per unit of effectiveness gained when compared to the next best treatment
- Calculate for less effective/less cost or most effective/more cost treatments
- DON’T CALCULATE/REPORT NEGATIVE ICER
8
Q
LYG
A
Life year gained
9
Q
ICER Equation
A
[Cost(New) - Cost(STD)]/[Effective(New) - Effect(STD)]
10
Q
Cost-Effective Plane
A
- Quad I/Quad III - Trade-off
- Quad II - Dominant
- Quad IV - Dominated
11
Q
Higher Cost/Lower Effectiveness
A
New dominated by STD
12
Q
Lower Cost/Higher Effectiveness
A
New dominates STD
13
Q
CEA Five Steps
A
- Make table of costs and effects
- Eliminate first order (strictly dominated) treatments
- Calculate ICER for each successive treatment
- Eliminate second order dominated (extended dominance) treatments
- Calculate final ratios
14
Q
First Order Dominated
A
- Program or treatment is more expensive AND provides less benefits/effects than another program (strongly dominated)
- Never efficient, always eliminate
15
Q
Which treatment should we use?
A
- ICER is effective but can’t be used alone to make final decision
- Utilize fixed budget or WTP approaches to make decision
16
Q
Budget as Decision
A
- Choice depends on size of budget
- Goal: maximize health given fixed budget
- Put non-dominated treatments in order of effectiveness/benefit
- Given budget, move to highest level of total costs in order of incremental costs, may need to split funds towards TWO programs
- Yields implied WTP value
17
Q
Budget Assumptions
A
- Patient uses only one treatment
2. You can split the budget between treatments
18
Q
Budget Between Two Costs?
A
-Use a mix of the two treatments
Set of Equations
P1 + P2 = 1
(P1 * Cost1) + (P2 * Cost 2) = Budget
- Solve for percentages of P1 and P2
- Yields different treatments for different patients
19
Q
WTP as Decision
A
- “Willing” to spend for a gain in benefit
- Choose option that covers the most costly treatment with an incremental ratio less than or equal to WTP (ICEP =< WTP)
- Same treatment for patient in same groups
- Yields a budget
20
Q
Limitations/Issues
A
- Limited/applicable to the single measure of benefit they used
- Difficult/impossible to compare treatments with different measures
- Don’t tell you whether treatment is worth implementing, still need WTP or budget
- Don’t always end up with population average effects: there is a risk
- Sometimes use CE ratios instead of ICER in studies, misleading and doesn’t inform on resource allocation so avoid its use
836
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