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Case 3 HPI4001 economics of healthcare
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Case 3 economics of healthcare
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Case 3 - Economic evaluation of health interventionsCase 3
1.Why do we need to conduct economic evaluation of healthcare innovations?
Why assess health technology?
Interest in tension between limited financial possibilities (health care budget constraint) and
unlimited / increase of health care needs / costs (new, expensive treatments, interventions and
innovations) → scarcity
Thus, need for choice, as there are not enough resources to meet all of society’s needs. Decisions
need to efficiently allocate health care resources. (reasonable decision making).
Evers, 2001: “Economic evaluation studies will be used more and more by policy makers as a basis for
their decisions. In addition, these economic evaluation studies will have an increasing impact on
clinical practice, in terms of pricing, coverage, and reimbursement. In some instances, there may be a
tension between those who wish to maximize effectiveness for the individual patient (e.g. the
clinicians) and those who wish to reduce costs at a macro level (e.g. the policy makers)”.
HTA: Health Technology Assessment “HTA is a multidisciplinary process that summarizes information
about the medical, social economical, and ethical issues related to the use of health technology in a
systematic, transparent, unbiased, robust manner.” (European Commission).
The aim of HTA
- To inform decision making
- To improve the quality of care by promoting an appropriate and rational use of health technologies
- To facilitate planning for the introduction and diffusion of new technologies / policies A lot of
dimensions are assessed in HTA (medical factors, economic factors and other factors) → criteria used
to assess medicinal products (European Parliament, 2015) see case 3 on this as well.
,Economic evaluation is a branch of HTA, other branches look at e.g. epidemiological, judicial, ethical,
and social aspects. The steps of economic evaluation: identification, measurement and valuation.
Economic evaluation looks at the costs and effects of (new) interventions.
The aim of economic evaluation:
- Provide a framework for identifying and comparing the costs and benefits of different options..
Drummond (2015) → in a systematic way: this increases the explicitness and accountability in
decision-making. The relevant alternatives are clearly identified.
- Inform decision makers about healthcare allocation
Economic evaluation is becoming increasingly important, due to:
- Increased attention to issues of costs and efficiency
- Increased use of economic data in decisions about the reimbursement or pricing of health
technologies.
- Formal use of economic data (e.g. drug reimbursement)
- Fourth hurdle to market access (economic evaluation is important for market access of drugs)
The steps of an economic evaluation:
1. Choose the perspective
2. Choose the type of economic evaluation
3. The identification of costs
4. Measurement of costs and effects
5. Compare and determine the difference in costs and the difference in effects
6. Estimate the ratio ICER and ICUR
7. Put the ratio into the cost-effectiveness plane and interpret the results
It’s important to assess health technologies because there is a tension between:
- Limited financial possibilities (constraints health care budget), and;
- Unlimited increase of health care costs (e.g. new, expensive treatments and innovations)
Objectives
- The objective of an economic evaluation is not to save money, but to ensure that resources are
used efficiently
- There are not enough resources to meet all the needs of the society. So choices have to be made. In
other words, efficiently allocate health care resources! What the most efficient allocation is, can be
assessed with economic evaluations.
- In recent years physicians increasingly have to concern themselves not only with the efficacy of care
and its acceptability to patients but also its economic efficiency. Doing economic evaluations and
providing them the results can help in making decisions
2 basis questions for policy makers
1. Are we currently efficient? Is the current allocation efficient?
2. How can we allocate the resources in a more efficient way?
, - Economic evaluation = part of HTA, different evaluations
- HTA = overall term
- Pharma-economics economic evaluation of pharmaceuticals
2.What is an economic evaluation and what are the types of economic
evaluations?
What is economic evaluation?
Comparative analysis between two or more health technologies in terms of costs and effects. So it’s
only an economic evaluation when you compare two or more aspects.
- Costs of intervention A and intervention B are compared to the effect of A and B
- Economic evaluation is a branch of HTA, as for instance epidemiological, judicial, ethical and social
aspects. So it economic evaluation can be seen as a pillar of HTA.
- Economic evaluations provide a framework for identifying and comparing the costs and benefits of
different options.
Uncertainty in economic evaluation
- Structural uncertainty (assumptions, methods)
- Parameters uncertainty (e.g. treatment effect)
- Heterogeneity (sex, age, subgroups) Because still needs to be addressed, a sensitivity analysis can
be performed!
Direct cost = drug itself, cost of informal care
Indirect costs; value of reduced productivity because they are sick
Intangible costs; emotional cost, pain, changes in mobility.
Questionaire: nog kijken naar lecture hier uitgelegd!!
QALY intentional quests are included for example by using QALY’s en cost utility
measures.
You can EQ5D questionnaire; you can derive later the QALY from these questionnaire
More methods but EQ5D is the most important one
Utility = score between 0 and 1 and described by the individual
Visual analogue scale; how to measure this scale between 0 and 1
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