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Dyslexia and Cost Effectiveness

Dyslexia and Cost Effectiveness. Prof. dr. Jan van Busschbach De Viersprong Erasmus MC. Health Economics. Comparing different allocations Should we spent our money on Wheel chairs Screening for cancer Dyslexia treatment Comparing costs Comparing outcome Outcomes must be comparable

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Dyslexia and Cost Effectiveness

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  1. Dyslexia and Cost Effectiveness Prof. dr. Jan van Busschbach De Viersprong Erasmus MC

  2. Health Economics • Comparing different allocations • Should we spent our money on • Wheel chairs • Screening for cancer • Dyslexia treatment • Comparing costs • Comparing outcome • Outcomes must be comparable • Make a generic outcome measure

  3. Outcomes in health economics • Specific outcome are incompatible • Allow only for comparisons within the specific field • Clinical successes: successful operation, total cure • Clinical failures: “events” • Number of correct spelled words • Generic outcome are compatible • Allow for comparisons between fields • Life years • Quality of life • Most generic outcome • Quality adjusted life year (QALY)

  4. Quality Adjusted Life Years (QALY) • Multiply life years with quality index • Quality of life index • 1.0 = normal health • 0.0 = death (extremely bad health) • Example • Losing sense of sight • Quality of life index is 0.5 • Life = 80 years • 0.5 x 80 = 40 QALYs

  5. QALY • Quality Adjusted Life Years • Area under the curve

  6. Which health care program is the most cost-effective? • A new wheelchair for elderly (iBOT) • Special post natal care

  7. Which health care program is the most cost-effective? • A new wheelchair for elderly (iBOT) • Increases quality of life = 0.1 • 10 years benefit • Extra costs: $ 3,000 per life year • QALY = Y x V(Q) = 10 x 0.1 = 1 QALY • Costs are 10 x $3,000 = $30,000 • Cost/QALY = 30,000/QALY • Special post natal care • Quality of life = 0.8 • 35 year • Costs are $250,000 • QALY = 35 x 0.8 = 28 QALY • Cost/QALY = 8,929/QALY

  8. 4500 Citations in PubMed

  9. QALY league table

  10. Dyslexia and QALYs • Request from CvZ • Cost effectiveness protocol dyslexia treatment • According to best standards • Pharmacoeconomics guidelines • 5 weeks…. • Leona Hakkaart • Costs • Elly Stolk • Outcome (Quality of Life)

  11. Model based on Patty Gerretsen 70 % 30 %

  12. Parameters • 70% effectiveness • N = 233, 1 year and 10 year • Gerretsen et al., 2006 • Costs • Protocol: € 4.445 • CAU: € 2.080 • N = 121 pre-treatment • Intake Regionaal Instituut voor Dyslexie • 200.000 children • 6% gets diagnostics • 1,8% treatment

  13. Effect on costs in 4 years But what about the effects on outcome? 70 % € 4.445 30 % € 4.445 € 2.080

  14. Outcome • Disease specific • Better reading skills • Better writing skills • Higher education • But what about generic effects? • Quality of life • QALYs

  15. Value health states dyslexia • No dyslexia, Mild, Severe

  16. Uni-dimensional value • Like the IQ-test measures intelligence • Ratio or interval scale • Difference 0.00 and 0.80 must be 8 time higher than 0.10 • Three popular methods have these pretensions • Visual analog scale • Time trade-off • Standard gamble

  17. Normal health X Dead Visual Analogue Scale • VAS • Also called “category scaling” • From psychological research • “How is your quality of life?” • “X” marks the spot • Rescale to [0..1]

  18. Time Trade-Off • TTO • Wheelchair • With a life expectancy: 50 years • How many years would you trade-off for a cure? • Max. trade-off is 10 years • QALY(wheel) = QALY(healthy) • Y * V(wheel) = Y * V(healthy) • 50 V(wheel) = 40 * 1 • V(wheel) = .8

  19. Of the shelf instrument: EQ-5D • MOBILITY • I have no problems in walking about • I have some……. • I am confined to bed • SELF-CARE • I have no problems with self-care • I have some problems….. • I am unable… • USUAL ACTIVITIES • I have no problems with performing my usual activities • I have some problems… • I am unable…. • PAIN/DISCOMFORT • I have no pain or discomfort • I have moderate ….. • I have extreme…….. • ANXIETY/DEPRESSION • I am not anxious or depressed • I am moderately…….. • I am extremely….. • Patient sample • “Woortblind” • N = 265 • Out of 820 • Response rate 32.3% • EQ-5D • Patients 0.87 (sd 0.16) • Norm 0.88 (sd 0.16) Not sensitive in Dyslexia

  20. Severe dyslexia Severe dyslexia Severe dyslexia ADHA Crohn Mild Asthma Paired comparisons

  21. Quality of life weights

  22. Elementary school € 33.513 Basis school Grammar school € 16.332 Middelbare school Secondary education € 11.558 Vervolgonderwijs Costs per QALY

  23. QALY league table

  24. Limitations • Conservative estimates • No involved cost of repeaters • Only costs of CUA in first year • No good estimates of additional income • Limited effect estimates • No RCT • No formal estimates of uncertainty

  25. ISPOR 2007

  26. Conclusion • Cost per QALY is feasible in dyslexia • Cost per QALY of treatment is reasonable • Cost effectiveness successfully uses as argument in reimbursement • There is a need for better… • Estimates of effects • Estimates quality of life • Models

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