a methodology for measuring the cost- utility of early childhood developmental interventions quality...
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A METHODOLOGY FOR MEASURING A METHODOLOGY FOR MEASURING THE COST- UTILITY OF EARLY THE COST- UTILITY OF EARLY
CHILDHOOD DEVELOPMENTAL CHILDHOOD DEVELOPMENTAL
INTERVENTIONSINTERVENTIONS
Quality of improved life Quality of improved life opportunities (QILO) opportunities (QILO)
Why Do We Need Economic Why Do We Need Economic Analysis?Analysis?
Evaluate political policies (economic perspective)Evaluate political policies (economic perspective) Realisation of benefits for participants, their Realisation of benefits for participants, their
families, and the communityfamilies, and the community Attract further investment (private and public)Attract further investment (private and public) To evaluate the efficiency of programs To evaluate the efficiency of programs
(prioritisation of resources)(prioritisation of resources) Effectiveness = $ Savings and Benefits Effectiveness = $ Savings and Benefits
Benefits and Savings Benefits and Savings Benefit/cost analyses of early childhood
developmental interventions
$9
5,6
46
.00
$2
0,3
84
.00
$5
,39
9.0
0
$4
1,3
08
.00
$1
2,3
56
.00
$6
,08
3.0
0
$3
,01
7.0
0
$6
,69
2.0
0
$-$20,000.00$40,000.00$60,000.00$80,000.00
$100,000.00$120,000.00
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Net savings
Program cost
Current methodsCurrent methods
Cost AnalysisCost Analysis Cost-Effectiveness AnalysisCost-Effectiveness Analysis Cost-Savings AnalysisCost-Savings Analysis Cost-Benefit AnalysisCost-Benefit Analysis
Governmental PerspectiveGovernmental Perspective
Governmental PerspectiveGovernmental Perspective Short and long term benefits or savings to Short and long term benefits or savings to
governmentgovernment
““Might government funds invested early in the lives Might government funds invested early in the lives of children yield compensating decreases in of children yield compensating decreases in
government expenditures”?government expenditures”?
Problems with this approachProblems with this approach
– Unable to measure disparate programsUnable to measure disparate programs– Frames the case for developmental prevention Frames the case for developmental prevention
too narrowlytoo narrowly– Disjuncture between program objectives and Disjuncture between program objectives and
program evaluation criteriaprogram evaluation criteria– Neglects potential benefits with important Neglects potential benefits with important
consequences for society at largeconsequences for society at large Improved public safetyImproved public safety Living an effective an productive lifeLiving an effective an productive life
The societal perspectiveThe societal perspective
Identifying a common metric outcomeIdentifying a common metric outcome A holistic approach to valuing benefits on an A holistic approach to valuing benefits on an
individual level.individual level. Measures benefits across multiple domains, Measures benefits across multiple domains,
at different times, but still on an individual at different times, but still on an individual level.level.
Possibility of valuing alternative life courses.Possibility of valuing alternative life courses.
Adaptation of QALYsAdaptation of QALYs
Help us make better resource allocation Help us make better resource allocation decisionsdecisions
Choices between groups (clientele/patient) Choices between groups (clientele/patient) competing for specific forms of care are competing for specific forms of care are made explicitmade explicit
Prioritisation of resourcesPrioritisation of resources Provides another piece in the complex Provides another piece in the complex
jigsaw puzzle.jigsaw puzzle.
Concept behind QALYsConcept behind QALYs
Common metric for assessing the extent of Common metric for assessing the extent of benefits gained from a variety of benefits gained from a variety of interventionsinterventions
Quantity and quality of life gainsQuantity and quality of life gains
Quantity and quality of lifeQuantity and quality of life
A QALY places a weight on time in different A QALY places a weight on time in different health stateshealth states
Quantity of life is expresses in terms of Quantity of life is expresses in terms of survival or life expectancysurvival or life expectancy
Quality of life embraces not only health Quality of life embraces not only health status but also a range of other health states status but also a range of other health states e.g. physical and mental capacity e.g. physical and mental capacity
Measuring Quality of lifeMeasuring Quality of life
Standard gambleStandard gamble Time trade-offTime trade-off Rating scalesRating scales Mulitattribute utility functionsMulitattribute utility functions
UtilitiesUtilities Utilities produced represent valuations Utilities produced represent valuations
attached to each health state attached to each health state Continuum between 0 &1 Continuum between 0 &1
Instruments that produce utilitiesInstruments that produce utilities
EQ-5DEQ-5D SF-36SF-36 Health Utilities Index Health Utilities Index (HUI1)(HUi2)(HUI3)(HUI1)(HUi2)(HUI3)
EuroQol-5D EuroQol-5D
Instruments that produce utilitiesInstruments that produce utilities
Arriving at QALY Arriving at QALY Benefits (QALYs)=
Number of QALYs saved through preventing or delaying premature death
+ number of QALYs gained through illness avoided or delayed
- number of QALYs lost from side effects
- loss of benefits from substitution for other drugs or treatment regimes
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Amount of time spent in health state is weighted by the utility score given to that state
Arriving at QALY Arriving at QALY
Data relating to Health Related Quality of Life = Impact of intervention on an individual patient (with and without intervention)
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Arriving at QALY Arriving at QALY
Cost utility ratioCost utility ratio
Difference between the costs of two Difference between the costs of two interventions divided by the difference in the interventions divided by the difference in the QALYs they produceQALYs they produce
Cost utility ratio 2Cost utility ratio 2
E.g. Treatments for a disease T1 & T2E.g. Treatments for a disease T1 & T2T1 generates 0.5111 QALYsT1 generates 0.5111 QALYsT2 generates 0.6016 QALYsT2 generates 0.6016 QALYs
T1 QALY – T2 QALY = 0.0905 QALYsT1 QALY – T2 QALY = 0.0905 QALYs 33 days of perfect health (0.0905 x 365)33 days of perfect health (0.0905 x 365) Addition cost of T2 = $220/patientAddition cost of T2 = $220/patient Therefore it costs $2,431 (220/0.0905) to Therefore it costs $2,431 (220/0.0905) to
generate an additional QALY by using T2generate an additional QALY by using T2
Where to?Where to?– Adapting the methodology (QILO)Adapting the methodology (QILO)– Framing and designing the studyFraming and designing the study – Estimating costs (using methodology developed by Manning, 2004)Estimating costs (using methodology developed by Manning, 2004) – Discounting costsDiscounting costs – Identifying relevant outcomesIdentifying relevant outcomes – Describing the element states and their possible course over time for Describing the element states and their possible course over time for
individuals who receive the intervention and for those who receive each individuals who receive the intervention and for those who receive each alternative.alternative.
– Attain weights for various states (survey)Attain weights for various states (survey)– Combining the elements of each state (measures of effectiveness) into a Combining the elements of each state (measures of effectiveness) into a
single number reflecting the value assigned to that state (Multi-attribute single number reflecting the value assigned to that state (Multi-attribute utility)utility)
– Integrating the values assigned to the statesIntegrating the values assigned to the states – Estimating the probabilities of each outcomeEstimating the probabilities of each outcome – computing a numerical average outcome for each of the alternatives being computing a numerical average outcome for each of the alternatives being
compared.compared.