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Health Economics, CEA in Health, Comparison, Decision rules, measurements,…

- - - - Cost-effectiveness acceptability curve (CEAC)
    - - Tornado Diagram
- - - - the cost of available intervention / Per agreed health goal
        
        Less vs. more frequent screening / (per positive found)
        
        Mobile vs. fixed facility service delivery / (per surgery)
        
        More vs. less intensive tretment (per life year added)
- - - - only one outcome can be considered at a point in time, for example
        
        cost of life you saved will not tell you anything about the quality of those years
      - such as number of heart attack avoided versus number of hip fracture avoided.
    - - at times, the relationship between the outcome measure and health might not be cleared especially when the unit of effect is a biological measure such as
        
        tumor size
        
        caries depth
- - - - Resources used to design, implement, access or continue the intervention(s) being evaluated
        
        Direct non-healthcare cost
        
        Ambulances
        
        Transportation
        
        Direct healthcare cost
        
        Medication
        
        hospital beds
      - Direct costs are resources used in the design, implementation, accessing or continuation
        of the intervention(s) being evaluated and are usually the main focus of a cost
        analysis. They are the costs of providing or accessing health services and can be incurred
        by either the provider or patient. Both should be included unless the study perspective
        dictates otherwise. Direct costs can be further classifi ed as direct health care and
        direct non-health care costs.
        • Direct health care costs are those costs essential to the implementation, receipt and
        continuation of the health service. They are the resources spent on health care;
        • Direct non-health care costs are resources used in connection with the health service
        but are not health sector costs. Examples include the cost of transport to and
        from the facility or catering in hospitals.
    - - Other resources used as a result of the intervention
        
        Lost income / productivity
        
        time spent commuting ( by patients of family member_
      - In addition to direct costs, other resources might be used as a result of the health
        intervention. Indirect costs refer to resources like the patient’s time that is taken up
        going to the hospital, rather than working. Similarly, other family members may also
        have to change their work schedules to take over some of the jobs that would have
        been done by the patient, or to accompany the patient to receive care. The time of
        other family members used for these reasons is also counted as an indirect cost.
        Indirect costs are commonly measured using wages and earnings lost. If wages and
        earnings are not available or the person is not working, alternative methods can be
        used to fi nd the value of their time
    - - Pain / Suffering
        
        pain and suffering due to side-effects from treatment or anxiety
      - Anxiety
        
        anxiety about whether the treatment will be effective
      - Some interventions may themselves cause pain and suffering such as side-effects from
        treatment or anxiety about whether the treatment will be effective. The value of pain
        and suffering is termed an intangible cost. Because measuring intangible costs is a diffi
        cult task, most economic evaluations do not calculate them. However, you should
        bear in mind that intangible costs could be major factors affecting the patient’s and
        society’s decision regarding treatment options.
- - - - CEA
      - Number of cases
        
        dental caries / cavities
      - Intermediate measures
        
        dental plaque
      - Tooth brushing programme
      - Healthcare utilization
        
        dental care visits due to carries
      - Disease-specific quality of life
        
        Oral disease questionnaire
        
        OHrQoL
    - - CUA
      - Number of deaths
      - Generic quality of life measures
        
        e.g. EuroQol-dimensions (EQ-5D)
        
        HR-QoL
      - Utility measures
        
        e.g. Quality-adjusted life-years (QALY)
        
        Most commonly used in economic evaluation
        
        An outcome measure based on survival weighted by quality of life
        
        scored between 0 for death and 1 for full health
        
        1 QALY = 1 year in full health
        
        it is a generic measure of disease burden, including both the quality and the quantity of life lived.
        
        it is used in economic evaluation to assess the value of medical interventions
        
        it combines the quality of life and length of life into a single index measure
        
        to measure QALY, we multiply the length of life (years) X by Quality of Life (0 dead -1 perfect health)
        
        QALYs are a health indicator which measures the
        amount of years of life lived, taking into consideration that some of those life years are
        lived in less than perfect health. An individual will have more QALYs the longer he or
        she lives and the better health he or she enjoys during those years. QALYs are therefore a measure of health gain, which is a ‘good’ of which an individual wishes to have as
        much as possible. Levels of health are described using a scale with anchor points of
        0 (death) and 1 (full health) and the principle of combining the quantity and quality of
        life years. The example below illustrates how the calculation is made.
        
        Disability-adjusted life-years (DALYs)
        
        ). DALYs are a measure of healthy time lost caused by diseases in an individual or a
        population. This indicator combines the life years lost due to premature death with years
        lived in a health state less than full health. An individual will suffer a larger burden of DALYs
        lost the shorter he or she lives and the worse health he or she experiences. DALYs are
        therefore a measure of the health gap between actual health and a defi ned ideal for health
        achievement. This gap is a ‘bad’ which an individual or population would strive to minimize.
      - CBA
  - - - **Time-Trade-Off (TTO) is a technique used to measure the quality of life that a person or group is experiencing. An individual will be presented with a set of directions such as:
        Imagine that you are told that you have 10 years left to live. In connection with this you are also told that you can choose to live these 10 years in your current health state or that you can choose to give up some life years to live for a shorter period in full health. Indicate with a cross on the line the number of years in full health that you think is of equal value to 10 years in your current health state.[1]
        The answer given by the individual shows how many years in the current health state they would be willing to 'trade off', in order to regain full health. This answer can be used to calculate the individual's quality of life in that health state.**
        
        The standard gamble Iaims at measuring the ‘disutility’ of a health state by observing the willingness to accept a certain risk of death in order to avoid the state.
        
        The VAS method utilizes a thermometer-type instrument such as that shown in
        Figure 15.3 to help respondents attach values to different health states. A number of
        different health states are described to respondents who are then asked to place
        these on the scale with mild health problems near the top of scale and severe
        health states near the bottom. Endpoints of the scale are typically framed as ‘best
        imaginable health state’ and ‘worst imaginable health state’ or ‘full health’ and
        ‘death’. While the VAS has often been used for direct measurement of health states,
        it has some limitations. Many respondents have diffi culty assigning interval scale
        values to health states and tend instead to merely rank them. Moreover, the method
        does not give the respondent a choice between two alternatives and therefore
        does not refl ect the strength of preference necessary for economic evaluation.
        There is also a concern that rating scales are subject to measurement biases such as
        end-of-scale bias, where respondents tend to avoid the extremes
    - - CBA
        
        Observed (or ‘revealed’) preferences
        
        Observed preference studies examine the actual choices (i.e. preferences) that
        decision-makers or individuals express in real life. These are interpreted as revealing the
        relative value placed on different consequences and risks
        
        stated preference
        
        An alternative approach for estimating indirect costs and benefi ts uses surveys to elicit
        the maximum amount individuals are willing to pay (WTP) to receive something or to
        avoid something. While less common, surveys may also measure willingness to accept
        (WTA), which is the minimum monetary amount necessary for an individual to forego
        some good, or to bear some harm. In health care, stated preference studies have been
        used to estimate the value of new interventions or services for which there may not
        be a market, in order to assess whether the cost of the proposed intervention justifi es
        the potential benefi t to society. T
        
        indirect cost