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Economic evaluation of health programmes. Department of Epidemiology, Biostatistics and Occupational Health Class no. 3: What to look for in an economic evaluation (continued) + examples Sept 10, 2008. Plan of class. Finish going over checklist for assessing an economic evaluation
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Economic evaluation of health programmes Department of Epidemiology, Biostatistics and Occupational Health Class no. 3: What to look for in an economic evaluation (continued) + examples Sept 10, 2008
Plan of class • Finish going over checklist for assessing an economic evaluation • A note on the notion of efficiency • Assess two articles (Hlatky et al., Weisbrod et al.) • Were costs and consequences measured accurately in appropriate physical units?
Were all important and relevant costs and consequences for each alternative identified? • Look at Figure 3.1 • In practice, we usually don’t measure everything, it would take too long. • Easier to justify if we know from other studies that a cost element is likely to be negligible/not related to the intervention. • Let’s work through an example!
Were costs and consequences measured accurately in appropriate physical units? IDENTIFICATION: WHICH KINDS OF COSTS OR CONSEQUENCES WILL WE MEASURE? MEASUREMENT: COUNT THE NUMBER OF EACH KIND …
Were costs and consequences valued credibly? VALUATION: ASSIGN A VALUE (TO OUTCOME; OR ELSE A VALUE IN DOLLARS TO A COST)
Were costs and consequences adjusted for differential timing? • Discount both costs and outcomes
Was an incremental analysis of costs and consequences of alternatives performed?
Was allowance made for uncertainty in the estimates of costs and consequences? • Methodological • Sampling variation • Extrapolation • Generalisability
Did the presentation of study results include all issues of concern to users? • Intelligent interpretation of costs in relation to outcomes? • Comparison with other analysts’ results? • Discussion of generalizability to other settings/other patient groups? • Other potentially important factors, e.g., ethical concerns, distributional consequences? • Discussion of implementation issues?
EFFICIENCY IS THE OUTCOME WORTH PURSUING IN RELATION TO OTHER OUTCOMES, GIVEN RESOURCES REQUIRED? (Allocative efficiency) O2 O3 O1 IS IT THE INTERVENTION THAT ACHIEVES AN OUTCOME USING THE FEWEST RESOURCES? (Productive efficiency) I1 I2 IS AN INTERVENTION DELIVERED WITH AS FEW RESOURCES AS POSSIBLE? (Productive efficiency) I1 I1 ineff
Checklist summary (1) • Does the question correspond to the economic evaluation of a health program? • Was a comprehensive description of the alternatives given? • Was the effectiveness of the program or intervention or treatment well established? • Were all important and relevant costs and consequences for each alternative identified? • Were costs and consequences measured accurately in appropriate physical units?
Checklist summary (2) • Were costs and consequences valued credibly? • Were costs and consequences adjusted for differential timing? • Was an incremental analysis of costs and consequences of alternatives performed? • Was allowance made for uncertainty in the estimates of costs and consequences? • Did the presentation of study results include all issues of concern to users?
