Transcript Term project topics

Economic evaluation of health
programmes
Department of Epidemiology, Biostatistics
and Occupational Health
Class no. 6: Cost-effectiveness analysis –
Part I
Sept 17, 2008
Plan of class
Finish material from previous class
Term project topics
Valuing productivity gains or losses
Obtaining effectiveness data
Discounting future benefits
Term project topics
2 teams of 3 or 3 teams of 2
3 suggested types of topics:
 Detailed design of a CEA, CUA or CBA
(including draft questionnaires, etc.)
 Analysis of an existing data set, including
calculation of unit costs
 Design and execution of a methodological
study, e.g., a willingness-to-pay study, using a
convenience sample of respondents
 Open to other suggestions!
Valuing productivity gains or
losses: Human capital approach
Conventional, usual method
 Labor gained or lost valued at what it costs
(Wage rate, including any benefits or other
charges covered by employer)
• Use average wage rate for age and sex, or wage
rate for particular workers affected
 Value of production at the margin
Valuing productivity gains or
losses: Friction cost approach
What does it actually cost to the economy
if a worker misses a day of work to go to
the doctor?
What if a sick person can go back to work
– what is the gain to the economy?
 Friction cost: Value of production lost due to
time needed to find a replacement worker and
restore production to previous level
Will the friction cost or the
human capital approach yield the
highest estimates of productivity
losses due to people being taken
out of the workforce?
Will this vary according to the
length of time the person is
taken out of the workforce?
http://cadth.ca/media/pdf/186_
EconomicGuidelines_e.pdf
Use the friction cost approach to value lost time
from paid work. Report the friction period and unit
cost used to value lost productivity. Gross wage
rates plus the costs associated with recruiting and
training replacement workers can be used to
value long-term absences from work. Exclude the
lost time from paid work due to premature death
that occurs beyond the friction period.
Source: 2.10 f, page 9
However: No Canadian estimates of the friction period exist;
would vary by industry, type of worker
Equity considerations
What is the effect of taking into account
effects of productivity changes on the
relative attractiveness of different
programs?
Is this a reason for favouring use of the
friction cost method?
Risk of double counting
Overlapping measures
Difference in
cost of
interventions
Difference
in outcome
+
+
Change in
productivity
Valuation of
effect on income
?
?
Suggestions
 Report productivity changes separately
 Report quantities (e.g., days of work lost)
separately from any value attributed to them
 Use both human capital and some estimate of
friction cost method
 Consider equity implications
 Double-counting?
 Follow any official guidelines (in Canada,
CADTH)
CEA or CUA?
Turtle soup was tangy
Tables were attractively decorated
Service was prompt and attentive
Salmon was ordinary
Decor was so-so
Price was moderate
VS.
Overall value for money: 4/5!
CEA
or
CCA
Need for good effectiveness
data
Efficacy vs effectiveness
Study protocols may influence outcome
 Adjust if possible
Selective use of studies?
If no evidence, use sensitivity analysis
Intermediate vs final
outcomes
Intermediate outcomes: T4 cell counts,
medication adherence, blood pressure,
cholesterol levels…
Discounting benefits
Controversy whether to also discount
benefits
But logical inconsistencies arise if benefits
and costs not discounted at the same rate
So in practice best to discount at the same
rate (report results with 5%, 3%, 0% for
both)
See book for more detailed discussion