University:
Michigan State University
Course:
PHM 430 | Human Pharmacology
Academic year:

2024
Views:

452

Pages:

26
Author:

lankstoetp16

Cost-Effectiveness Analysis Cost-effectiveness analysis (CEA) • Is used when the treatment alternatives are not therapeutically equivalent or when outcomes cannot be expressed in monetary units. • Cost is measured in monetary units, and outcomes are expressed in terms of obtaining a specific therapeutic objective, such as cases cured, lives saved, or millimeters of mercury drop in blood pressure. • Cost-effectiveness analysis allows researchers to summarize the health benefit and resources used by two or more competing programs so that policymakers can choose among them Overview of CEA CEA measures costs in dollars outcomes in natural health units (cures, lives saved, or BP reductions) Overview of CEA • The most common type of PE analysis found in the pharmacy literature • An advantage: • Health units are common outcomes that are routinely measured in clinical trials (familiar to practitioners) Not designed to cut costs, but how to use healthcare resources better! Why do we need CEA Drug A 25 strokes $180,000 Drug B 50 strokes $100,000 Which drug is preferred ? Overview of CEA • A limitation is that the alternatives must have outcomes that are measured in the same clinical units • CEA can not be used to compare the outcomes of an antiHTN product with the outcomes of an asthma product • Even if products for similar diseases or conditions are compared, more than one type of clinical outcome may be important • Example: when measuring the effects of hormone replacement therapies: • the effect on menopausal symptoms • The effect on bone mineral density measures • This may justify the calculation of multiple cost-effectiveness ratios for the comparison Overview of CEA • For many medications, both the effectiveness in treating the disease and the side effects of treatment may differ significantly between alternative treatments • Example: one chemotherapy regimen may be more effective in lengthening the time until the disease progresses than another chemotherapy regimen, but the more effective regimen may also cause more toxic side effects • With the CEA method, it is difficult to collapse different outcomes into one unit of measurement Presentation of Costs & Effectiveness • Measuring the results or outcomes of medications used to treat stomach ulcers may be based on • the patient’s reports of symptom reductions • or based on follow-up endoscopies Example • Data in the following table correspond to the costs and outcomes of treating stomach ulcers using 3 therapy options (drugs A, B, or C) and using 2 outcome measures • SFDs during the year • Percent healed (patients in whom endoscopy indicated that the ulcer was healed) Examples of Ways To Present Cost and Effectiveness Results Presentation of Costs & Effectiveness • The 1st method of presenting results includes listing the costs and various outcomes without conducting ratios; this is termed a cost-consequence analysis (CCA) • The 2nd method includes calculating the average costeffectiveness ratio (CER) for each alternative • The CER is the ratio of resources used per unit of clinical benefit Presentation of Costs & Effectiveness • More often the question is, “How does one treatment compare with another treatment in costs & outcomes?” • An incremental cost-effectiveness ratio (ICER) is calculated to answer this common question • The ICER is the ratio of the difference in costs divided by the difference in outcomes • When one of the alternatives is both more expensive and more effective than another, the ICER is used to determine the magnitude of the added cost for each unit in health improvement CE Example Cost of Tx Treatment Treatment 2 1 $100 $250 Effectiveness 10 mg/dL 20mg/dL $10 $12.5 per 1 mg/dL per 1 mg/dL Drop in low-density lipoprotein cholesterol C/E Incremental cost = 250-100=$150 Incremental effectiveness= 20-10= 10 mg/dL ICER (treatment 2 vs 1)= 150/10 = $15/ extra1 mg/dL drop Cost-Effectiveness Grid • Used to illustrate the definition of “cost-effectiveness” • To determine if a therapy or service is cost effective, both the costs and effectiveness must be considered • If the new treatment is… 1. 2. 3. more effective and less costly (cell G) more effective at the same price (cell H) has same effectiveness at a lower price (cell D) ✓The new therapy is considered cost effective (darkly shaded cells) Cost-Effectiveness Grid Cost-Effectiveness Grid • On the other hand, if the new drug is … 1. less effective and more costly (cell C) 2. has same effectiveness but costs more (cell F) 3. has lower effectiveness for the same costs (cell B), ✓Then the new product is not cost effective (lightly shaded cells) • There are three other possibilities (cells with no shading) Cost-Effectiveness Grid • Example of ulcer treatment: • when comparing B with A, and when comparing C with A, these comparisons would fall into cell G of the grid, indicating dominant cost-effectiveness for both B and C compared with A • when comparing C with B, this comparison would fall into cell I of the grid, indicating an ICER should be calculated • using C compared with using B would cost 6.40 more for every extra SFD, or 3200 more for every extra healed ulcer • Is C cost effective compared with B? That depends if the evaluator believes the extra cost is worth the extra health benefit Cost-Effectiveness Grid Cost-Effectiveness Plane • A graphical depiction of cost-effectiveness comparisons • The point on the plane where the x & y axes cross indicates the starting point of costs and effectiveness for the standard comparator • A point is placed in the plane for each alternative to the standard comparator by indicating how much more or less it costs than the starting point (y-axis) and how much more or less effective it is than the starting point (x-axis) Cost-Effectiveness Plane Cost-Effectiveness Plane • If an alternative is … • more expensive & more effective the point would fall in quadrant I and the trade off of the increase in costs for the increase in benefits would need to be considered • less expensive & more effective, the point would fall in quadrant II (dominant) • less costly & less effective, the point would fall in quadrant III, and a trade off would have to be considered (Do costs savings outweigh its decrease in effectiveness?) • more expensive & less effective, the point would fall in quadrant IV (dominated) Cost-Effectiveness Plane • The ulcer example: • For drug B compared with drug A and drug C compared with drug A, points in the cost-effectiveness plane would fall into quadrant II (dominant) • If we change the comparator to drug B, because drug C is both more expensive and more effective than drug B, the cost-effectiveness point would appear in quadrant I (tradeoff) Intermediate Outcomes versus Primary Outcomes • Primary or final outcomes (e.g., cure of a disease, eradication of an infection) are preferred units of measurement • When it is not feasible to collect primary outcomes because of time or monetary resources, intermediate or surrogate outcomes (e.g., lab. measures, BP measurements) are used as surrogate endpoints • The limitation of using intermediate outcomes is reduced as the strength of the association between the intermediate and primary outcome measures increases Efficacy vs. Effectiveness • Many PE studies use data from randomized clinical trials (RCTs) • These studies are sometimes referred to as cost-efficacy analyses • RCTs are the gold standard for determining if a medication is efficacious, and they are required by the FDA before a medication can be approved for use. • RCTs are used to establish efficacy-“if a drug can work”- under relatively ideal conditions • PE studies are more interested in the assessment of effectiveness-“if a drug does work”- in real-world practice • Results from RCTs should be used with caution in PE analyses Summary • CEA is the most common type of PE research seen in the literature • The advantage of using CEA is that outcomes are measured in clinical units, which are familiar and acceptable to clinicians • The disadvantages: • only one outcome at a time can be compared • although an incremental cost-effectiveness ratio (ICER) can provide an estimate of the additional cost for the additional clinical benefit, readers must make a judgment call as to whether the additional cost is worth the additional benefit Summary • Costs and outcomes can be presented independently without calculating ratios using cost-consequence analysis (CCA), by calculating the average cost per outcome using a cost-effectiveness ratio(CER), or by calculating the incremental cost per incremental outcome using an ICER • To graphically illustrate the results of a CEA, a cost-effectiveness grid or costeffectiveness plane may be used • Although the measurement of final or primary outcomes is preferred, intermediate outcomes may be a more practical measure for some diseases or conditions • If data from randomized controlled trials(RCTs) are used, the term costefficacy analysis may be more appropriate because results may not be similar to those of everyday clinical practice

Cost-Effectiveness Analysis

Related Documents

Recommended Documents

Description

Related Documents

Free up your schedule!

Take 5 seconds to unlock