Summary
exam
Economic Evaluation in
Healthcare
Week 1
Boek
Different types of economic evaluation
The comparison of alternative options in terms of their costs and consequences
, 1. Cost-consequence analysis
The simplest way of reporting the costs and consequences of two interventions
would be to calculate and report all the various costs and consequences in a
separate and disaggregated way, leaving the reader or decision-maker to
interpret and synthesize them in some way.
2. Cost-minimization analysis
Again, both costs and health outcomes or consequences are of interest, but in
this case it is assumed that the health outcomes for two or more options are
identical, and so the option that has the lowest costs will be preferred: the
objective has become minimization of costs
3. Cost-effectiveness analysis
We first calculate the costs and effects of an intervention and more alternatives,
then calculate the differences in cost and differences in effect, and finally present
these differences in the form of a ratio (the cost per unit of health outcomes or
effect)
- Because the focus is on differences between two (or more) options,
analysts typically refer to incremental costs (or effects), and the
incremental-cost-effectiveness ratio (ICER).
o driehoekje betekent incremental …
- Measured in QUALY’s
- Calculate against the next best alternative
4. Cost-benefit analysis
Does attempt to place some monetary valuation on health outcomes as well as
on healthcare resources. It is more firmly based on welfare theory than cost-
effectiveness analysis, and it aims to include all benefits and not just the health
outcomes that cost-effectiveness analysis focuses on
- Society and employment
5. Cost-effectiveness plane
- Plot the incremental cost and the incremental benefit of the new
intervention vs the comparator (current treatment, no treatment,
alternative).
- C = origin of the graph, represents the point of comparison or control
Cost-effectiveness ratios that have been calculated against the baseline or do-
nothing option without reference to any alternatives are referred to as average
cost-effectiveness ratios (ACER), while comparisons with the next best
alternative are described as incremental cost-effectiveness ratios (ICER)
1
, Cost-effectiveness frontier: Draw a line through all the options for any
given level of spending and with the available options, health gain we be
maximized by choosing one of the treatments on that frontier.
When one option is more effective and less costly: this one is described as
dominance
"Mutually exclusive" means that two or more things cannot occur or exist at
the same time.
Using cost-effectiveness to maximize health gain calculate QUALYs
(incremental effectiveness) and ICER cost per QUALY, and calculate the
cumulative of both
Slides
Measures of occurrence
- Prevalence: the number of cases of a given disease at a given moment
per 1000
o Prevalence of chronic diseases: the prevalence of first episodes of
depression in the Netherlands in 2017 was about 5.2%
- Incidence: the number of new cases of a given disease at a given time
per 1000
o The incidence of new cases of depression in the Netherlands in 2017
was 4%
Relationship between them:
Incidence rate: number of subjects developing disease during a given time :
number of person-time at risk
- Out of non-diseased persons, 28 develop a depression over a two-year
period
o Incidence rate = 14 per 1000 person-years
2
exam
Economic Evaluation in
Healthcare
Week 1
Boek
Different types of economic evaluation
The comparison of alternative options in terms of their costs and consequences
, 1. Cost-consequence analysis
The simplest way of reporting the costs and consequences of two interventions
would be to calculate and report all the various costs and consequences in a
separate and disaggregated way, leaving the reader or decision-maker to
interpret and synthesize them in some way.
2. Cost-minimization analysis
Again, both costs and health outcomes or consequences are of interest, but in
this case it is assumed that the health outcomes for two or more options are
identical, and so the option that has the lowest costs will be preferred: the
objective has become minimization of costs
3. Cost-effectiveness analysis
We first calculate the costs and effects of an intervention and more alternatives,
then calculate the differences in cost and differences in effect, and finally present
these differences in the form of a ratio (the cost per unit of health outcomes or
effect)
- Because the focus is on differences between two (or more) options,
analysts typically refer to incremental costs (or effects), and the
incremental-cost-effectiveness ratio (ICER).
o driehoekje betekent incremental …
- Measured in QUALY’s
- Calculate against the next best alternative
4. Cost-benefit analysis
Does attempt to place some monetary valuation on health outcomes as well as
on healthcare resources. It is more firmly based on welfare theory than cost-
effectiveness analysis, and it aims to include all benefits and not just the health
outcomes that cost-effectiveness analysis focuses on
- Society and employment
5. Cost-effectiveness plane
- Plot the incremental cost and the incremental benefit of the new
intervention vs the comparator (current treatment, no treatment,
alternative).
- C = origin of the graph, represents the point of comparison or control
Cost-effectiveness ratios that have been calculated against the baseline or do-
nothing option without reference to any alternatives are referred to as average
cost-effectiveness ratios (ACER), while comparisons with the next best
alternative are described as incremental cost-effectiveness ratios (ICER)
1
, Cost-effectiveness frontier: Draw a line through all the options for any
given level of spending and with the available options, health gain we be
maximized by choosing one of the treatments on that frontier.
When one option is more effective and less costly: this one is described as
dominance
"Mutually exclusive" means that two or more things cannot occur or exist at
the same time.
Using cost-effectiveness to maximize health gain calculate QUALYs
(incremental effectiveness) and ICER cost per QUALY, and calculate the
cumulative of both
Slides
Measures of occurrence
- Prevalence: the number of cases of a given disease at a given moment
per 1000
o Prevalence of chronic diseases: the prevalence of first episodes of
depression in the Netherlands in 2017 was about 5.2%
- Incidence: the number of new cases of a given disease at a given time
per 1000
o The incidence of new cases of depression in the Netherlands in 2017
was 4%
Relationship between them:
Incidence rate: number of subjects developing disease during a given time :
number of person-time at risk
- Out of non-diseased persons, 28 develop a depression over a two-year
period
o Incidence rate = 14 per 1000 person-years
2
