Measuring and Valuing Health Benefits for Economic Evaluation

2016 ◽  
Author(s):  
John Brazier ◽  
Julie Ratcliffe ◽  
Joshua Saloman ◽  
Aki Tsuchiya
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Benefits ◽  
Empirical Work ◽  
Health Benefit ◽  
Quality Adjusted Life Year ◽  
Health State ◽  
Cultural Issues ◽  
Utility Values ◽  
Recent Developments

This is the second edition of the first comprehensive textbook about the measurement and valuation of health benefits for economic evaluation. The National Institute for Health and Care Excellence (NICE) and similar agencies around the word require cost-effectiveness evidence in the form of incremental cost per quality-adjusted life year (QALY) in order to make comparisons across competing demands on resources, and this has resulted in an explosion of theoretical and empirical work in the field. This book addresses the theoretical and practical considerations in the measurement and valuation of health benefit with empirical examples and applications to help clarify understanding and make relevant links to the real world. It includes a glossary of key terms and provides guidance on the use of different methods and instruments. This updated edition provides an-up-to date review of the theoretical basis of the QALY; the definition of health; the techniques of valuation (including ordinal); the modelling of health state values (including mapping between measures); a detailed review of generic preference-based measures and other instruments for obtaining health state utility values (with recent developments); cross-cultural issues (including the disability-adjusted life year); the aggregation of QALYs; and the practical issues surrounding the use of utility values in cost-effectiveness models. The book concludes with a discussion on the way forward in light of the substantial methodological differences, the role of normative judgements, and where further research is most likely to take forward this fascinating component of health economics.

Within trial cost-effectiveness of a structured lifestyle intervention in adults with overweight/obesity and type 2 diabetes: Results from the Action for Health in Diabetes (Look AHEAD) Study

2020 ◽  
Author(s):  
Ping Zhang ◽  
Karen M. Atkinson ◽  
George Bray ◽  
Haiying Chen ◽  
Jeanne M. Clark ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Lifestyle Intervention ◽  
Health Utility Index ◽  
Health Benefit ◽  
Cost Effective ◽  
Health Utility ◽  
Health Care Expenditures ◽  
Quality Adjusted Life Year

<b>OBJECTIVE </b>To assess the cost-effectiveness (CE) of an intensive lifestyle intervention (ILI) compared to standard diabetes support and education (DSE) in adults with overweight/obesity and type 2 diabetes, as implemented in the Action for Health in Diabetes study. <p><b>RESEARCH DESIGN AND METHODS</b> Data were from 4,827 participants during the first 9 years of the study from 2001 to 2012. Information on Health Utility Index-2 and -3, SF-6D, and Feeling Thermometer [FT]), cost of delivering the interventions, and health expenditures were collected during the study. CE was measured by incremental cost-effectiveness ratios (ICERs) in costs per quality-adjusted life year (QALY). Future costs and QALYs were discounted at 3% annually. Costs were in 2012 US dollars. </p> <p><b>RESULTS </b><a>Over the </a>9 years studied, the mean cumulative intervention costs and mean cumulative health care expenditures were $11,275 and $64,453 per person for ILI and $887 and $68,174 for DSE. Thus, ILI cost $6,666 more per person than DSE. Additional QALYs gained by ILI were not statistically significant measured by the HUIs and were 0.17 and 0.16, respectively, measured by SF-6D and FT. The ICERs ranged from no health benefit with a higher cost based on HUIs, to $96,458/QALY and $43,169/QALY, respectively, based on SF-6D and FT. </p> <p><b>Conclusions </b>Whether<b> </b>ILI was cost-effective over the 9-year period is unclear because different health utility measures led to different conclusions. </p>

The economic evaluation of complementary medicine: a staged approach at the Royal London Homoeopathic Hospital

2000 ◽  
Vol 89 (S 01) ◽  
pp. S23-S26 ◽  
Author(s):  
R van Haselen
Keyword(s):  
Rheumatoid Arthritis ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Complementary Medicine ◽  
Evidence Base ◽  
Practical Implementation ◽  
Health State ◽  
Marginal Costs ◽  
Related Quality ◽  
Staged Approach

AbstractObjective: The practical implementation of a staged, multifaceted research agenda for the economic evaluation of complementary medicine (CM) at the Royal London Homoeopathic Hospital (RLHH).Method: The relative importance of economic evaluation as an evidence base of CM was assessed via a survey conducted with purchasers (n=481). The marginal costs of providing complementary care for patients with rheumatoid arthritis were calculated. The use, and changes in the use, of conventional medicines for patients’ main complaints were established retrospectively (n=499) and prospectively (n=70). Health-related quality of life (patient utility) of newly referred patients was assessed with the EQ-5D (EuroQol) instrument (n=70) on a 100 mm (0=worst, 100=best) scale.Results: Economic evaluation was rated ‘important’ as an evidence base, after safety and RCT data (‘very important’). Consultation time (doctors and dietician) contributed 29% of the total costs of treating rheumatoid arthritis. The retrospective survey showed that many patients on conventional medication were able to stop (29%) or reduce (32%) intake in the course of treatment. The median (quartiles) health state of newly referred patients was 70 mm (50,78) in men and 60 mm (36,73) in women. Some results of an interim analysis of 6 months follow-up data are reported.Conclusions: Economic evaluation of CM is becoming increasingly important and should take place by using a multifaceted, staged approach. Before embarking on randomised trials, observational data on cost, effectiveness and utility should be collected. The cost-effectiveness of CM appears to be most sensitive to the duration of the consultation.

scholarly journals Economic evaluation of ‘Men on the Move’, a ‘real world’ community-based physical activity programme for men

2020 ◽  
Author(s):  
Liam Kelly ◽  
Michael Harrison ◽  
Noel Richardson ◽  
Paula Carroll ◽  
Tom Egan ◽  
...  
Keyword(s):  
Public Health ◽  
Physical Activity ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Health Improvement ◽  
Community Based ◽  
Life Years ◽  
The Impact

Abstract Background Physical activity (PA) interventions capable of producing health benefits cost effectively are a public health priority across the Western world. ‘Men on the Move’ (MOM), a community-based PA intervention for men, demonstrated significant health benefits up to 52-weeks (W) post-baseline. This article details the economic evaluation of MOM with a view to determining its cost-effectiveness as a public health intervention to be rolled out nationally in Ireland. Methods Cost-effectiveness was determined by comparing the costs (direct and indirect) of the programme to its benefits, which were captured as the impact on quality-adjusted life-years (QALYs). For the benefits, cost–utility analysis was conducted by retrospectively adapting various health-related measures of participants to generate health states using Brazier et al.’s (2002) short form-6D algorithm. This in turn allowed for ‘utility measures’ to be generated, from which QALYs were derived. Results Findings show MOM to be cost-effective in supporting an ‘at risk’ cohort of men achieves significant improvements in aerobic fitness, weight loss and waist reduction. The total cost per participant (€125.82 for each of the 501 intervention participants), the QALYs gained (11.98 post-12-W intervention, or 5.3% health improvement per participant) and estimated QALYs ratio costs of €3723 represents a cost-effective improvement when compared to known QALY guidelines. Conclusions The analysis shows that the cost per QALY achieved by MOM is significantly less than the existing benchmarks of £20 000 and €45 000 in the UK and Ireland respectively, demonstrating MOM to be cost-effective.

scholarly journals How are we evaluating the cost-effectiveness of companion biomarkers for targeted cancer therapies? A systematic review

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mikyung Kelly Seo ◽  
John Cairns
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
Health State ◽  
Cancer Therapies ◽  
Companion Diagnostics ◽  
Targeted Cancer Therapies ◽  
Biomarker Testing ◽  
The Cost

Abstract Background Despite the increasing economic assessment of biomarker-guided therapies, no clear agreement exists whether existing methods are sufficient or whether different methods might produce different cost-effectiveness results. This study aims to examine current practices of modeling companion biomarkers when assessing the cost-effectiveness of targeted cancer therapies. It investigates the current methods in modeling the characteristics of companion diagnostics based on existing economic evaluations of biomarker-guided therapies in cancer. Methods A literature search was performed using Medline, Embase, EconLit, Cochrane library for economic evaluations of biomarker-guided therapies with companion diagnostics in cancer. Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies were selected using pre-specified eligibility criteria based on the PICO framework. To make the included studies more comparable, we qualitatively synthesized the data under nine domains of methods where consensus was deemed lacking. Results Only four of the twenty-two studies included in this review were found to be of good quality with respect to incorporating the characteristics of companion biomarkers in economic evaluations. However, many evaluations focused on a pre-selected patient group rather than including all patients regardless of their biomarker status. Companion biomarker characteristics captured in evaluations were often limited to the cost or the accuracy of the test. Often, only the costs of biomarker testing were modelled. Clinical outcomes and health state utilities were often not included due to the limited data generated by clinical trials. Methods of economic evaluation were not applied consistently in assessments of companion cancer biomarkers for targeted therapies. It was also shown that conflicting cost-effectiveness results were likely depending on what comparator arm was chosen and what comparison structure was designed in the model. Conclusion We found no consistent approach applied in assessing the value of companion biomarker tests and including the characteristics of biomarkers in an economic evaluation of targeted oncology therapies. Currently, many economic evaluations fail to capture the full value of companion biomarkers beyond sensitivity/specificity and cost related to biomarker testing.

scholarly journals A systematic review of health state utility values for thyroid cancer

2020 ◽  
Author(s):  
Rachel Houten ◽  
Nigel Fleeman ◽  
Eleanor Kotas ◽  
Angela Boland ◽  
Tosin Lambe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Thyroid Cancer ◽  
Cost Effectiveness ◽  
Differentiated Thyroid Cancer ◽  
Health State ◽  
Health States ◽  
Utility Values ◽  
Sf 36 ◽  
Health State Utility Values ◽  
Eortc Qlq

Abstract Purpose Health state utility values are commonly used to inform economic evaluations and determine the cost-effectiveness of an intervention. The aim of this systematic review is to summarise the utility values available to represent the health-related quality of life (HRQoL) of patients with thyroid cancer. Methods Eight electronic databases were searched from January 1999 to April 2019 for studies which included assessment of HRQoL for patients with thyroid cancer. Utility estimates derived from multiple sources (EuroQol questionnaire 5-dimension (EQ-5D), time trade-off [TTO] and standard gamble [SG] methods) were extracted. In addition, utility estimates were generated by mapping from SF-36 and EORTC QLQ-30 to the EQ-5D-3L UK value set using published mapping algorithms. Results Searches identified 33 eligible studies. Twenty-six studies reported HRQoL for patients with differentiated thyroid cancer and seven studies for patients with general thyroid cancer. We identified studies which used different methods and tools to quantify the HRQoL in patients with thyroid cancer, such as the EQ-5D-3L, SF-36, EORTC QLQ-30 and SG and TTO techniques to estimate utility values. Utility estimates range from 0.205 (patients with low-risk differentiated thyroid cancer) to utility values approximate to the average UK population (following successful thyroidectomy surgery and radioiodine treatment). Utility estimates for different health states, across thyroid cancer sub-types and interventions are presented. Conclusion A catalogue of utility values is provided for use when carrying out economic modelling of thyroid cancer; by including mapped values, this approach broadens the scope of health states that can be considered within cost-effectiveness modelling.

scholarly journals Economic Evaluation of Medical Screening

2019 ◽  
Author(s):  
Eline Aas ◽  
Emily Burger ◽  
Kine Pedersen
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Health Benefits ◽  
Cost Effective ◽  
Population Based ◽  
Preventive Interventions ◽  
Screening Strategies ◽  
The Cost ◽  
Analytic Models

The objective of medical screening is to prevent future disease (secondary prevention) or to improve prognosis by detecting the disease at an earlier stage (early detection). This involves examination of individuals with no symptoms of disease. Introducing a screening program is resource demanding, therefore stakeholders emphasize the need for comprehensive evaluation, where costs and health outcomes are reasonably balanced, prior to population-based implementation. Economic evaluation of population-based screening programs involves quantifying health benefits (e.g., life-years gained) and monetary costs of all relevant screening strategies. The alternative strategies can vary by starting- and stopping-age, frequency of the screening and follow-up regimens after a positive test result. Following evaluation of all strategies, the efficiency frontier displays the efficient strategies and the country-specific cost-effectiveness threshold is used to determine the optimal, i.e., most cost-effective, screening strategy. Similar to other preventive interventions, the costs of screening are immediate, while the health benefits accumulate after several years. Hence, the effect of discounting can be substantial when estimating the net present value (NPV) of each strategy. Reporting both discounting and undiscounted results is recommended. In addition, intermediate outcome measures, such as number of positive tests, cases detected, and events prevented, can be valuable supplemental outcomes to report. Estimating the cost-effectiveness of alternative screening strategies is often based on decision-analytic models, synthesizing evidence from clinical trials, literature, guidelines, and registries. Decision-analytic modeling can include evidence from trials with intermediate or surrogate endpoints and extrapolate to long-term endpoints, such as incidence and mortality, by means of sophisticated calibration methods. Furthermore, decision-analytic models are unique, as a large number of screening alternatives can be evaluated simultaneously, which is not feasible in a randomized controlled trial (RCT). Still, evaluation of screening based on RCT data are valuable as both costs and health benefits are measured for the same individual, enabling more advanced analysis of the interaction of costs and health benefits. Evaluation of screening involves multiple stakeholders and other considerations besides cost-effectiveness, such as distributional concerns, severity of the disease, and capacity influence decision-making. Analysis of harm-benefit trade-offs is a useful tool to supplement cost-effectiveness analyses. Decision-analytic models are often based on 100% participation, which is rarely the case in practice. If those participating are different from those not choosing to participate, with regard to, for instance, risk of the disease or condition, this would result in selection bias, and the result in practice could deviate from the results based on 100% participation. The development of new diagnostics or preventive interventions requires re-evaluation of the cost-effectiveness of screening. For example, if treatment of a disease becomes more efficient, screening becomes less cost-effective. Similarly, the introduction of vaccines (e.g., HPV-vaccination for cervical cancer) may influence the cost-effectiveness of screening. With access to individual level data from registries, there is an opportunity to better represent heterogeneity and long-term consequences of screening on health behavior in the analysis.

scholarly journals A Cost-Effectiveness Analysis of Atezolizumab and Bevacizumab Verses Sorafenib in Patients With Advanced Hepatocellular Carcinoma

2021 ◽  
Author(s):  
Meiyue Li ◽  
Peili Lin ◽  
Shaohong Luo ◽  
Xiaoting Huang ◽  
Xiaojia Huang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Health Benefit ◽  
Life Time ◽  
Cost Effective ◽  
Health State ◽  
Advanced Hepatocellular Carcinoma ◽  
Life Years

Abstract Background: Several studies have evaluated the cost-effectiveness of treatment for advanced hepatocellular carcinoma (HCC), but the economics of atezolizumab plus bevacizumab (Ate plus Beva) remains unclear. Method: A three-state Markov model was established to simulate the life-time cost and effectiveness of advanced liver cancer, which included costs and health outcomes. Medical costs were sourced from Red Book, Healthcare Cost and Utilization Project (HCUP) and literatures. Also, the utility values of health state were deprived from references. The primary outcomes were measured by life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-benefit ratio (ICER) and incremental net-health benefit (INHB). The robustness of the model was verified by one-way and probabilistic sensitivity analysis.Results: Ate plus Beva generated a gain of 0.84 QALYs (1.17 LYs ), an additional incremental cost of $242,447.40 per patient as compared with sorafenib, which resulted in the ICER of $288,663.09/QALY ($206,906.76/LY) at the willingness-to-pay (WTP) threshold of $150,000/QALY, and the INHB was -0.78/QALY. The sensitivity analysis demonstrated that the ICER was most affected by the price of atezolizumab.Conclusion: From the U.S. health care payer perspective, compare with sorafenib, Ate plus Beva regimen seems unlikely to be cost-effective in advanced HCC patients at a WTP threshold of 150,000 /QALY. If the price of atezolizumab was reduced by 75%, the probability of atezolizumab being cost-effective was over 50% at the WTP threshold.

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