Transcript CPDALY < GNP per head COST EFFECTIVE

WHAT IS HEALTH
ECONOMICS?
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ACCOUNTANTS CARE ONLY ABOUT
$$$$$$$$$$
PHYSICIANS CARE ONLY ABOUT
PATIENTS……
HEALTH ECONOMISTS CARE ABOUT
RESOURCE$ AND PATIENTS
ECONOMICS IS HOW TO ALLOCATE
SCARCE RESOURCES
COST-EFFECTIVENESS
ANALYSIS (CEA)
SAME GOAL
A
5
B
10
C
4
The cheapest method of attaining
the SAME GOAL
is the most cost-effective.
CHRONIC RENAL
DISEASE (Klareman)
HOSP DIALYSIS ($104,000)
9 years gained. CPLY=$11,600
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HOME DIALYSIS ($38,000)
9 years gained. CPLY=$4,200
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TRANSPLANT ($44,500)
17 years gained CPLY=$2,600
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BURDEN
Process I
1.
Literature
search
Analysis,
review
2.
Epi
parameters
3.
Country
data
4.
Burden
Estimates
BURDEN
SCENARIOS
Fig 2: Projected Hepatitis A Cases with and without Vaccination
Program in Kazakhstan 2002-2041
40,000
Cases
30,000
20,000
10,000
0
2002
2006
2010
2014
2018
2022
2026
2030
2034
2038
BURDEN
PROGRAM
COSTS
SCENARIOS
BURDEN
VACCINE
PROGRAM
COSTS
SCENARIOS
DISEASE
TREATMENT
COSTS
Utilisation Rates for: self-care, self
care +medication/herbs, traditional
healer, community clinic/GP, inhospital care, intensive care, outpatient visits.
X
DISEASE
TREATMENT
COSTS
Unit Costs, including Laboratory tests,
Pharmaceuticals and Medications.
+
COSTS OF DISEASE SEQUELLAE
NET COST PER DALY
Net Cost = Cost of Intervention less
Averted Treatment Costs
DALYS = sum of life years saved
due to decreased mortality + life
years saved due to decreased
morbidity + reduction in
caregiver burden
DALY LOSS PER FRACTURE
Morbidity
Mortality
Hip
Vertebral
Proximal-humerus
Distal-radius
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
2
NET COST
DALY
PER: LIFE YEAR GAINED
LIFE SAVED
CASE-PREVENTED
COST-UTILITY ANALYSIS
COST SAVING
IF savings in treatment costs
> program costs
then we can reduce mobidity and
mortality AT NO NET COST
STRONG PSYCHOLOGICAL PUSH
FOR PROGRAMME
VERY COST EFFECTIVE
 Project
considered
acceptable in relation to
resources available in
individual countries
CPDALY < GNP per head
COST EFFECTIVE
 Project
considered
acceptable in relation to
resources available in
individual countries
CPDALY < 3 x GNP per head
ALBANIA has $1,120 GNP per
Head, CPDALY for HIB=$347
CPDALY < 3 x GNP per
head
 VERY cost-effective if
 WHO report, says project is
cost-effective if
CPDALY < GNP per head
Disease Clubs
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Many donors adopt specific
diseases, creating jobs and
disease clubs, who advocate
using burden data, but avoid
true comparisons of
interventions using CEA.
BURDEN:Deaths
100
80
60
40
20
0
A
B
C
D
E
BURDEN:Life Years Lost
Disease B occurs at younger age
5000
4000
3000
2000
1000
0
A
B
C
D
E
BURDEN: DALY
Dis. C has high morbidity & sequelae
6000
4000
2000
0
A
B
C
D
E
SCENARIO: Potential DALYS SAVED
Disease D has high intervention efficacy
5000
4000
3000
2000
1000
0
A
B
C
D
E
$40
CUA: Cost per DALY:
Disease E has low intervention cost
$30
$20
$10
$0
A
B
C
D
E
3,500 additional DEATHS PREVENTED with
$10m budget
9000
6000
3000
0
A
E
250,000 extra DALYS SAVED WITH $10m
BUDGET
600000
400000
200000
0
A
E
INFECTIOUS
 Good
efficacy
data, short
length of
trials
 Hard to
model herd
immunity
NCD
 Poor
efficacy
data due to
long term
needed for
results
(statins,
latency period)
Prevention Programmes
 Eg:
smoking cessation or dietary
control
 Very little population based
efficacy data as trials usually were
on specific populations such as
persons employed in factory etc.
GCEA: THREE
PROGRAMME EXAMPLE
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A = Operation on rare disease
(Cost = $1m, QALYS saved = 1)
B = Operation and drug
treatment for rare disease (Cost =
$1,001,000, QALYS saved = 2)
C = Preventive Nutritonal
Campaign (Cost = $1,001,000,
QALYS= 500)
$
1m
A
B
C
A to B, get 1 QALY for
$1000 CPQALY = $,1000
0
1
2
QUALYS
Cost =
$ 1,001,000
QALY=500
CPQALY=
$2,000
500
INCREMENTAL CEA
 CHOOSE
B SINCE CPQALY
= $1,000 cf
$2000 for nutrition
programme
$
1m
CPQ=$1,000,000
A
B
C
CPQ= $500,500
CPQ=2,000
0
1
2
QUALYS
500
GENERALISED CEA
CALCULATE NULL SETTING WHERE
NO INTERVENTION OCCURS
 CALCULATE ALL INTERVENTIONS
WITH RESPECT TO NULL
 CHOOSE INTERVENTION C AND
GAIN
2000-2 = 1998 QALYS
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COST per QALY ($)
Low er CHOL
by drugs
22640
Breast Ca
Screening
9248
Kidney
Transplant
7536
Hip
replacement
GP smoking
cessation
1888
432
Low er CHOL 352
by diet
0
5
10
15
Thousands
20
25
CEA or CUA
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TRANSPARENT, MORE
DEMOCRATIC METHOD OF
CHOOSING PROGRAMMES THAN
BY MARKET, PRESSURE GROUPS,
DONOR GROUPS ETC.
BIASED AGAINST ELDERLY AND
HANDICAPPED!
MORE EFFICIENT METHOD IN
TERMS OF MAXIMISING HEALTH
OUTPUT (DALYS- reflecting
mortality and morbidity gains)
HEALTH ECONOMICS
WITHOUT
HEALTH ECONOMICS
THANK YOU
………...….…..opportunity
cost