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RESCUE: Assessing Health and Economic Outcomes

RESCUE: Assessing Health and Economic Outcomes. William C. Black, M.D. Dartmouth-Hitchcock Medical Center. Outline. Health outcomes Economic outcomes CEA. Health Outcomes. MACE / Revacularization Life years (Vital Status) QALYs (SF-36) @ BL, 12 mos Angina Status. Life Years.

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RESCUE: Assessing Health and Economic Outcomes

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  1. RESCUE: Assessing Health and Economic Outcomes William C. Black, M.D. Dartmouth-Hitchcock Medical Center

  2. Outline • Health outcomes • Economic outcomes • CEA

  3. Health Outcomes • MACE/ Revacularization • Life years (Vital Status) • QALYs (SF-36) @ BL, 12 mos • Angina Status

  4. Life Years • All observed deaths thru trial • All projected deaths after trial Framingham survival estimates based on age, sex, and CV events

  5. Quality Adjusted Life Year • Measure of patient utility • Measured on a scale of 0-1.0 • Can be assessed directly or derived, SG vs SF-36

  6. Standard Gamble

  7. 1.0 Quality Adjusted Life Years QALY = 0.5+0.25 = 0.75 Quality of Life 0.5 0 0.5 1.0 Quantity of Life

  8. QALYs

  9. QALYs • Derived from SF-36 @ BL, 1 yr • SS-6D utility scoring • Adjusted for age after trial

  10. SF-6D • Physical functioning • Role limitations • Social functioning • Pain • Mental health • Vitality

  11. SF-6D Utility Scoring U = 1.000 + ∑Score – 0.070 Brazier et al. J Health Econ 2002;21:271-92.

  12. QoL - Angina • CCS @ BL, 6, 12, 18, & 24 mos • SAQ @ BL, 12 mos • Not “preference” based

  13. Economic Outcomes • Direct cardiac* • inpatient care • outpatient care • medications • Indirect cardiac* • time and travel

  14. Economic Outcomes • Based on 201x dollars • Adjusted for timing w MC CPI • Projected by age beyond trial

  15. Hospitalization Costs • Triggered by patient questionnaire • DRGs and CPTs coded by MRA • Medicare reimbursement • Part A MEDPAR • Part B Physician Fee Schedule

  16. Outpatient Costs • Triggered by patient questionnaire • CPTs coded by MRA • Medicare Physician Fee Schedule • Red Book avg wholesale prices

  17. Indirect Costs • Triggered by patient questionnaire • Travel and other expenses • Timefrom usual activities

  18. CEA • Societal perspective • In-trial and lifetime horizons • Discounting @ 3% • Sensitivity analysis

  19. Base Case

  20. c II I ? Not Cost-Effective e III ? IV Cost-Effective Black. Med Decis Making 1990. 10(3): 212-4.

  21. c K II IB IA e IIIA IIIB IV Black. Med Decis Making 1990. 10(3): 212-4.

  22. Uncertainty • Sensitivity analysis • Scatterplot of ICE • CE Acceptability curves

  23. Sensitivity Analysis • LE • QALE • Costs • In-trial • Beyond-trial

  24. Weintraub, W. S. et al. Circ CardiovascQual Outcomes 2008;1:12-20

  25. Bootstrap Method • Sample n CTA subjects, compute C*CT, E*CT • Sample m SPE subjects, compute C*SP, E*SP • Plot ICE: (C*CT – C*SP, E*CT - E*SP) • Repeat steps 1-3 N times * mean

  26. Fenwick et al. BMC Health Serv Res 2006;6:52.

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