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L9 Economics Evaluation 2 :pineapple: (:star:Efficiency Economics AnalysisâĶ
L9
Economics Evaluation 2
:pineapple:
Health Technology Assessment
(HTA)
āļāļēāļĢāļāļĢāļ°āđāļĄāļīāļāđāļāļāđāļāđāļĨāļĒāļĩāļāđāļēāļāļŠāļļāļāļ āļēāļ ðĪ
āļāļāļāđāļāļ & āļāļĢāļāļāļāļēāļĢāļĻāļķāļāļĐāļē
of HLA
āļāļĢāļ°āđāļĄāļīāļāļāļ§āļēāļĄāļāļļāđāļĄāļāđāļēāļāļēāļāļāļēāļĢāđāļāļāļĒāđ āļāļ§āļĢāļĄāļĩ
āļāļēāļĢāļāļģāļŦāļāļ
Health technology āļāļĩāđāđāļĢāļēāļŠāļāđāļ
āļāļģāđāļĢ, duration?, how to do?, how often!?
Target population
(āļāļāļ.āđāļāđāļēāļŦāļĄāļēāļĒ)
Consider fr
āļĨāļąāļāļĐāļāļ°āļāļēāļĢāļāļĢāļ°āļāļēāļĒāđāļāļīāļāļāļāļ.
â Age, Sex, Economical status, Disease āļāļĩāđāđāļāđāļ, Severity of ds, Cooperation in using drugs
Comparator
(āļāļąāđāļāļāļąāļ§āđāļāļĢāļĩāļĒāļāđāļāļĩāļĒāļ)
: options that comparing âInterested Health Technologyâ
Current practice (mayb option that often use)
Standard clinical practice guideline (Rx āļāļĩāđāđāļāđāļĢāļąāļāļāļēāļĢāļĒāļāļĄāļĢāļąāļāļ§āđāļēāļĄāļĩāļāļĢāļ°āļŠāļīāļāļāļīāļ āļēāļāļŠāļđāļāļŠāļļāļāđāļāļāļāļ°āļāļąāđāļ)
Minimal clinical practice (āļāļēāļĢāļĢāļąāļāļĐāļēāļāļąāđāļāļāđāļģāļāļĩāđāļĒāļāļĄāļĢāļąāļ)
Do nothing (āļāļēāļĢāđāļĄāđāđāļāđāļĢāļĩāļāļāļēāļĢāļĢāļąāļāļĐāļē)
Perspectives
(āļĄāļļāļĄāļĄāļāļ)
Depends on
Purpose āđāļāļāļēāļĢāļāļģāđāļāđāļāđāļāļĢāļ°āđāļĒāļāļāđ
for example
Patient
perspective
eg Direct cost that pt pay himself,
canât āđāļāļīāļ,
also include Paid Indirect cost
Provider
perspective
eg Provider is the one who paid;
doesnât include Indirect cost
âClinic Rx cost, Hospital cost
Payer
perspective
eg. Hospital care cost, CostāļāļĩāđāļāļĢāļ°āļāļąāļāļāđāļēāļĒ āļāļāļŠ. āļāļĢāļĄāļāļąāļāļāļĩāļāļĨāļēāļ āļŦāļĢāļ·āļ āļŠāļāļŠāļ.
Societal
perspective :star: most important perspective
eg. cover
both Direct & Indirect āļāđāļāļāļļāļ
, āļĄāļđāļĨāļāđāļēāļāđāļāļāļļāļāļĄāļēāļāļŠāļļāļ, Thai recommend to use this perspective to evaluate Economicâs āļāļ§āļēāļĄāļāļļāđāļĄāļāđāļē
Time horizon
(āļāļĢāļāļāđāļ§āļĨāļē)
Consider fr Time that using resources āđāļŦāđāļāļĢāļāļāļāļĨāļļāļĄ duration of study & along Basic of epidemiology
:star::star:
āļāđāļāļāļļāļāļāļēāļāđāļĻāļĢāļĐāļāļĻāļēāļŠāļāļĢāđ
:star::star:
Economical cost
:one:
Direct cost
(āļāđāļāļāļļāļāļāļēāļāļāļĢāļ)
:moneybag:
Direct Medical
cost
eg. āļāđāļē Dx ds, āļāđāļēāļĒāļē, āļāđāļēāļĢāļąāļāļĐāļē, āļāđāļēāđāļāļēāļ°āđāļĨāļ·āļāļ, āļāđāļēāļāļĢāļ§āļāļāļēāļlab, āļāđāļē X-ray, āļāđāļēāđāļāļĢāļ·āđāļāļāļĄāļ·āļ etc
:moneybag:
Direct Non-Medical
cost
eg. āļāđāļēāđāļāļīāļāļāļēāļāļĄāļēāļĢāļ, āļāđāļēāļāļēāļŦāļēāļĢāļāļ., āļāđāļēāļāļĩāđāļāļąāļ, āļāđāļēāļāđāļēāļāļāļāļāļđāđāļĨāļāļāļāļĩāđāļāđāļēāļ
:two:
Indirect cost
(āļāđāļāļāļļāļāļāļēāļāļāđāļāļĄ)
āļāļĨāļīāļāļāļĨāļāļĩāđ
āđāļŠāļĩāļĒ
āđāļāļāļēāļ
āđāļāđāļāļāđāļ§āļĒ āļŦāļĢāļ·āļ āļāļēāļĒāļāļāļāļāļ. āļŦāļĢāļ·āļ āļŠāļđāļāđāļŠāļĩāļĒāļāļāļāļāļđāđāļāļđāđāļĨāļāļ.
Eg. āđāļāļīāļāđāļāļ·āļāļ, āļāđāļēāļāđāļēāļāļĢāļēāļĒāļ§āļąāļ, āļĢāļēāļĒāđāļāđāļāļĩāđāđāļāļĒāđāļāđāļĢāļąāļāļĄāļēāļāđāļāļāđāļāđāļāļēāļāđāļāđāļāļ·āđāļāļāļāļēāļāļāļģāļāļēāļāđāļĄāđāđāļāđ, āļĢāļēāļĒāđāļāđāļāļāļāļāļđāđāļāļđāđāļĨāļāļđāđāļāđāļ§āļĒāđāļāļ·āđāļāļāļāļēāļāļāļēāļāļāļēāļ
:three:
Intangible cost
(āļāđāļāļāļļāļāļāļĩāđāđāļĄāđāļŠāļēāļĄāļēāļĢāļāļāļąāļāļāđāļāļāđāļāđ)
Pain, āļāļāļāļļāļāļāđāļāļĢāļĄāļēāļāļāļēāļāļāļēāļĢāđāļāđāļāļāđāļ§āļĒ
Not popular, not recommend āđāļŦāđāļāļģāļĄāļēāļāļīāļāļĢāļ§āļĄāđāļāļāđāļāļāļļāļāļāļąāđāļāļŦāļĄāļ**
āļāļēāļĢāļ§āļąāļāļāđāļāļāļļāļ
āļ§āļīāļāļĩāļ§āļąāļ
āļŦāļāđāļ§āļĒāđāļāļāļēāļĢāļ§āļąāļ
āđāļŦāļĨāđāļāļāđāļāļĄāļđāļĨ
Economic Evaluation
(āļāļĢāļ°āđāļĄāļīāļāļāļēāļāđāļĻāļĢāļĐāļāļĻāļēāļŠāļāļĢāđ)
āļ§āļīāđāļāļĢāļēāļ°āļŦāđāđāļāļĢāļĩāļĒāļāđāļāļĩāļĒāļ Health Technology & Health results fr using that Health Technology
Comparing in form of
:
āļāđāļāļāļļāļ (Input or Cost)
and
āļāļĨāļāļĩāđāđāļāļīāļāļāļķāđāļ (Output or Consequence-risk/benefit)
of each option
Notice :bulb:
Must have
at least 2
options or activities
Must interpret both
input & output
:star:
Efficiency Economics Analysis
:star:
:one: Cost-minimization Analysis (
CMA
)
or Cost-identification analysis
Comparing will led to
Identical outcomes
Only
Input is differ
Option with lowest input = best option!!
Few found in real situation
Interpret Lowest input, Intrepret Differences in Input
:two: Cost-Benefit Analysis (
CBA
)
Interpret āļāđāļāļāļļāļāļāļĨāđāļāđ, Interpret āļāļ§āļēāļĄāļāļļāđāļĄāļāļļāļ
Measure Input & Option results āļāļĩāđāļāļģāļĄāļē compare in Unit of money
so regardless resultsâ unit -> must change into
Unit of money
Some situation
canât evaluate Health results in Unit of Money
and Conflict with General feeeling
:three: Cost-Effective Analysis (
CEA
)
Interpret Input āļāļĢāļ°āļŠāļīāļāļāļīāļāļĨ
= Interpret āļāļĩāđāļ§āļąāļ & āļāļĩāļāđāļē āļāļāļāļĄāļēāđāļāđāļ
āļāļąāļ§āđāļāļīāļ
and
āļ§āļąāļāļāļĨ (outcome) āļāļāļāļĄāļēāđāļāđāļ
āļāļĢāļ°āļŠāļīāļāļāļīāļāļĨ (effectiveness)
Clinical outcomes, Health effects
Result that got from Clinical results eg. :arrow_down: Hypertension, No.of pt cure fr ds
:Fox: CEA uses
Life Year Gained (LYG)
(āļāļĩāļāļĩāđāđāļāļīāđāļĄāļāļķāđāļ)
:four: Cost-Utility Analysis (
CUA
)
Interpret Input āļāļĢāļĢāļāļāļĢāļ°āđāļĒāļāļāđ
Measure result as
Utility
āļāļ°āļ§āļąāļāļāļ§āļēāļĄāļāļļāđāļĄāļāđāļēāļāļĩāđāđāļŦāđ āļŠāļāļēāļāļ°āļāļēāļāļŠāļļāļāļ āļēāļ
Utility reflect
Preference(āļāļ§āļēāļĄāļāļķāļāļāļāđāļ)
of people toward result
eg. quality of life
:fox_face: CUA use
Quality Adjusted Life Year (QALY)
(āļāļĩāļŠāļļāļāļ āļēāļ§āļ°)
QALY
= Life Year x Utility score
Healthy ppl â QALY=1
Death â QALY=0
Note:
Life Year is Quantity
Utility score is Quality
Differ at
results
(must rmb result fr each Analysis)
Decision making
:male-cook::skin-tone-2:
:dog:
Steps in Interpreting CEA & CUA
āļāļģāļŦāļāļ problem
āļāļģāļŦāļāļ option that used for comparison
āļāļģāļŦāļāļ Input & Effectiveness(āļāļĢāļ°āļŠāļīāļāļāļīāļāļĨ) āļāļĩāđāļāļ°āļ§āļąāļ
Interpret cost of âInput&Effectivenessââ
āđāļāļĨāļāļĨ & āļĢāļēāļĒāļāļēāļāļāļĨ
Outcome Measurement
ðū â
ECHO model
:one:
Economic outcomes
Direct costs (medical related)
Indirect costs (Non-Medical related)
:two:
Clinical outcomes
Surrogate
Outcomes â easy to be measured, āđāļŦāđāļāļāļĨāđāļĢāđāļ§
Final
Outcomes âmeasure in long run, focus on Final results
Eg. Clinical events, Pso measures, Mortality, Length of stay (LOS), Hospital admission&readmission, ERorClinic visit
:three:
Humanistic outcomes
eg. utility, āļāļ§āļēāļĄāļāļķāļāļāļāđāļ
Life expectancy
Quality of life
(QOL)
Utility instrument
EQ-5D
:star::star:
develop into
EQ-5D-5L
:star:
Questionnaire for Evaluate quality of life in
general ppl
EQ = EuroQOL Group (Research Group in Europe help developing Quality of life Measurement āļāļĩāđāļŠāļąāđāļāđāļĨāļ°āđāļāđāļāđāļēāļĒ)
5D = 5 questions or 5 dimensions abt
Health
(each answer got 5 levels)
Health Utility Index
SF-36
WHO-BREF-THAI
Utility measurement
:dove_of_peace:
Direct
Utility measure
Visual analogue scale (VAS)
Standard Gamble (GM)
Time trade-off (TTO)
:dove_of_peace:
Indirect
Utility measure
EuroQOL (EQ-5D)
Health utility index (HUI)
Short form-36 (SF-36)
Health-related Quality of life
(HRQOL)
Patient satisfaction