quality of life in relation to costs
DESCRIPTION
Quality of life in relation to costs. Prof. Dr. Jan van Busschbach Medische Psychologie en Psychotherapie. Budget 2012 government NL . Raising costs in NL: 87 billion . More than growth national income. How much money is it worth?. Willingness to pay - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/1.jpg)
Quality of life in relation to costs
Prof. Dr. Jan van BusschbachMedische Psychologie en Psychotherapie
1
![Page 2: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/2.jpg)
Budget 2012 government NL
2
Volksgezondheid, Welzijn en Sport 75 29%Sociale Zaken en Werkgelegenheid 70 27%Onderwijs, Cultuur en Wetenschap 31 12%Gemeente- en provinciefonds 21 8%Buitenlandse Zaken 12 5%Infrastructuur en Milieu 11 4%Rentelasten 10 4%Defensie 7 3%Binnenlandse Zaken en Koninkrijksrelaties 4 2%Veiligheid & Justitie 10 4%Economische zaken, Landbouw en Innovatie 5 2%Financiën 2 1%Overig 0 0%
257 100%
![Page 3: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/3.jpg)
Raising costs in NL: 87 billion
3
![Page 4: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/4.jpg)
More than growth national income
4
![Page 5: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/5.jpg)
![Page 6: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/6.jpg)
How much money is it worth?
Willingness to pay Non familiarity with payment in health care Starting point error Strong relation with income
Does not do the job
6
![Page 7: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/7.jpg)
Framing the question helps…
Pair comparisons DCE, conjoint analysis
Comparisons between health care interventions remain difficult
7
Remove large scarInvolve painful operationCost € 500,-
Remove large scarInvolve painless operationCost € 1000,-
OR
![Page 8: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/8.jpg)
8
Health Economics
Comparing different allocations Should we spent our money on
• Wheel chairs• Screening for cancer
Comparing costs Comparing outcome
Outcomes must be comparable Make a generic outcome measure
8
![Page 9: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/9.jpg)
9
Outcomes in health economics
Specific outcome are incompatible Allow only for comparisons within the specific field
• Clinical successes: successful operation, total cure• Clinical failures: “events”
“Hart failure” versus “second psychosis”
Generic outcome are compatible Allow for comparisons between fields
• Life years• Quality of life
Most generic outcome Quality adjusted life year (QALY)
9
![Page 10: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/10.jpg)
Example Blindness Time trade-off value is 0.5 Life span = 80 years 0.5 x 80 = 40 QALYs
Quality Adjusted Life Years (QALY)
10
0.00
1.00
X
Life years40 80
0.5 x 80 = 40 QALYs
![Page 11: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/11.jpg)
11
Area under the curve
0 10 20 30 40 50 60 70 800
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Co-morbidityPsychotherapyNo psychotherapy
Life years
QA
LY w
eigh
ts
![Page 12: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/12.jpg)
12
Which health care program is the most cost-effective?
A new wheelchair for elderly (iBOT) Special post natal care
12
![Page 14: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/14.jpg)
14
Which health care program is the most cost-effective?
A new wheelchair for elderly (iBOT) Increases quality of life = 0.1 10 years benefit Extra costs: $ 3,000 per life year QALY = Y x V(Q) = 10 x 0.1 = 1 QALY Costs are 10 x $ 3,000 = $ 30,000 Cost/QALY = 30,000/QALY
Special post natal care Quality of life = 0.8 35 year Costs are $ 250,000 QALY = 35 x 0.8 = 28 QALY Cost/QALY = 8,929/QALY
14
![Page 15: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/15.jpg)
15
QALY league table
Intervention $ / QALYGM-CSF in elderly with leukemia 235,958
EPO in dialysis patients 139,623Lung transplantation 100,957End stage renal disease management 53,513
Heart transplantation 46,775Didronel in osteoporosis 32,047
PTA with Stent 17,889Breast cancer screening 5,147
Viagra 5,097Treatment of congenital anorectal malformations 2,778
15
![Page 16: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/16.jpg)
16
7000 Citations in PubMed
0100200300400500600700800900
1000
1975 1980 1985 1990 1995 2000 2005 2010 2015
Publ
icat
ions
1980[pdat] AND (QALY or QALYs)
![Page 17: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/17.jpg)
17
Direct valuation
![Page 18: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/18.jpg)
Time Trade-Off
Rolstoel 50 jaar levensverwachting
Hoeveel jaar zou je maximaal willen inleveren? Max. trade-off: 10 jaar
QALY(wiel) = QALY(voet) Y * V(wiel) = Y * V(voet) 50 V(wiel) = 40 * 1.00
V(wiel) = 0.80
18
![Page 19: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/19.jpg)
19
…or use validated questionnaires
MOBILITY I have no problems in walking about I have some problems in walking about I am confined to bed SELF-CARE I have no problems with self-care I have some problems washing or dressing myself I am unable to wash or dress myself USUAL ACTIVITIES (e.g. work, study, housework family or
leisure activities) I have no problems with performing my usual activities I have some problems with performing my usual activities I am unable to perform my usual activities PAIN/DISCOMFORT I have no pain or discomfort I have moderate pain or discomfort I have extreme pain or discomfort ANXIETY/DEPRESSION I am not anxious or depressed I am moderately anxious or depressed I am extremely anxious or depressed
![Page 20: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/20.jpg)
20
A problem in the patient perspective….
Stensman Scan J Rehab Med
1985;17:87-99. Scores on a visual
analogue scale 36 subjects in a
wheelchair 36 normal matched
controls Mean score
Wheelchair: 8.0 Health controls: 8.3
Healthy
Death
![Page 21: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/21.jpg)
21
Validated questionnaires Rosser EuroQol EQ-5D www.euroqol.org QWB SF-36 (SF-6D) www.sf-36.org HUI Mark 2 HUI Mark 3 15D www.15d-instrument.net
![Page 22: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/22.jpg)
EQ-5D-3L versus EQ-5D-5lZet bij iedere groep in de lijst hieronder een kruisje in het hokje achter de zin die het best past bij uw eigen gezondheidstoestand vandaag. Mobiliteit Ik heb geen problemen met lopen
Ik heb een beetje problemen met lopen
Ik heb matige problemen met lopen
Ik heb ernstige problemen met lopen
Ik ben niet in staat niet om te lopen Zelfzorg
Ik heb geen problemen met mijzelf wassen of aankleden
Ik heb een beetje problemen met mijzelf wassen of aankleden
Ik heb matige problemen met mijzelf wassen of aankleden
Ik heb ernstige problemen met mijzelf wassen of aankleden
Ik ben niet in staat mijzelf te wassen of aan te kleden Dagelijkse activiteiten (bijv. werk, studie, huishouden, gezins- en vrijetijdsactiviteiten)
Ik heb geen problemen met mijn dagelijkse activiteiten
Ik heb een beetje problemen met mijn dagelijkse activiteiten
Ik heb matige problemen met mijn dagelijkse activiteiten
Ik heb ernstige problemen met mijn dagelijkse activiteiten
Ik ben niet in staat mijn dagelijkse activiteiten uit te voeren Pijn/ongemak
Ik heb geen pijn of ongemak
Ik heb een beetje pijn of ongemak
Ik heb matige pijn of ongemak
Ik heb ernstige pijn of ongemak
Ik heb extreme pijn of ongemak Angst/somberheid Ik ben niet angstig of somber
Ik ben een beetje angstig of somber
Ik ben matig angstig of somber
Ik ben erg angstig of somber
Ik ben extreem angstig of somber
Zet bij iedere groep in de lijst hieronder een kruisje in het hokje achter de zin die het best past bij uw eigen gezondheidstoestand vandaag. Mobiliteit Ik heb geen problemen met lopen
Ik heb enige problemen met lopen
Ik ben bedlegerig
Zelfzorg
Ik heb geen problemen om mijzelf te wassen of aan te kleden
Ik heb enige problemen om mijzelf te wassen of aan te kleden
Ik ben niet in staat mijzelf te wassen of aan te kleden
Dagelijkse activiteiten (bijv. werk, studie, huishouden, gezins- en vrijetijdsactiviteiten)
Ik heb geen problemen met mijn dagelijkse activiteiten
Ik heb enige problemen met mijn dagelijkse activiteiten
Ik ben niet in staat mijn dagelijkse activiteiten uit te voeren
Pijn/klachten
Ik heb geen pijn of andere klachten
Ik heb matige pijn of andere klachten
Ik heb zeer ernstige pijn of andere klachten
Stemming
Ik ben niet angstig of somber
Ik ben matig angstig of somber
Ik ben erg angstig of somber
![Page 23: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/23.jpg)
23
Validating disease specific questionnaires
International Symptom Prostate Score (IPSS) BPH
Enlargement of the prostate Causes voiding problems in elderly men
• Difficulties to pee 7 questions: How often have you
had to push or strain to begin urination? had a sensation of not emptying your bladder completely? had to urinate again less than two hours after you finished urinating?
found you stopped and started again several times when you urinated?
you find it difficult to postpone urination? had a weak urinary stream? How many times did you most typically get up to urinate from the time
you went to bed at night until the time you got up in the morning?
![Page 24: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/24.jpg)
24
Can we convert the IPSS outcomes into utilities?
Attribute TTO values to the IPSS health states Problem: IPSS has 279.936 health states
7 items, 6 answer levels = 6x6x6x6x6x6x6 = 279.936 health states
Too many to value with TTO Reduce number of health states
Reduce items• Factor analysis
Reduce answer levels• Combine answer levels
![Page 25: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/25.jpg)
25
Factor analysis on patients IPSS responses N = 1414
Two main factors Obstructive (alpha= 0.8018) Irritative (alpha= 0.7165)
• Confirmed in literature Factors divided in 3 levels Number of health states reduced to 33 = 9
Can be valued directly TTO
General public, representative for gender/age (N=170)
Reduce number of health states
![Page 26: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/26.jpg)
26
QALY weights for BPH
almost always
sometimes
seldom/never
almost alwayssometimes
seldom/never
0,5
0,55
0,6
0,65
0,7
0,75
0,8
0,85
0,9
0,95
1
utilities (TTO)
obstructive
irritative
![Page 27: Quality of life in relation to costs](https://reader036.vdocument.in/reader036/viewer/2022062302/5681649c550346895dd68013/html5/thumbnails/27.jpg)
Conclusions
QALY can help to related quality of life to cost QALYs are the most accepted for of cost
effectiveness analysis At least in the Netherlands Might not be true in the US and Germany
QALY often need new validation of disease specific questionnaires.
27