1 / 14

Economic evaluation of health programmes

Economic evaluation of health programmes. Department of Epidemiology, Biostatistics and Occupational Health Class no. 20: More on dealing with uncertainty Nov 17, 2008. Plan of class. Net benefit framework Cost-effectiveness acceptability curves

freya
Download Presentation

Economic evaluation of health programmes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Economic evaluation of health programmes Department of Epidemiology, Biostatistics and Occupational Health Class no. 20: More on dealing with uncertainty Nov 17, 2008

  2. Plan of class • Net benefit framework • Cost-effectiveness acceptability curves • ‘Marrying econometrics and cost-effectiveness analysis’

  3. Bootstrapped replications that fall in all 4 quadrants Source: Drummond & McGuire 2001, p. 193

  4. Why is this a problem? • How do we construct a confidence interval when values within the interval fall into several quadrants? • Recall problem is: • Negative ICERs are not transitive: an intermediate value can represent a more cost-effective ICER than more extreme values • When the difference in effects is close to zero, the ICER becomes very large – and there is a discontinuity at zero. • As example shows, not at all clear how to define a confidence interval when replicates fall into all quadrants

  5. The net-benefit framework (1) Intervention considered cost-effective if: ICER = λ : maximum amount decision-maker willing to pay per unit of health gain (or ceiling ratio)

  6. The net benefit framework (2) Intervention is cost-effective if: We can trace the NMB as a function of λ, based on the sample values of mean difference in cost and effect:

  7. What is slope of NMB line? Where does it intersect the y axis? How are the 95% C.I. lines calculated? Where NMB =0, λ (here represented as RT) is equal to the ICER (see formula on previous page)

  8. CONSTRUCTING A CEAC: For various values of RT, we can estimate the probability that the intervention is cost-effective by counting the proportion of points that lie below the corresponding line

  9. Another cost-effectiveness acceptability curve (CEAC) Source: Drummond & McGuire 2001, p. 195 95% CI undefined: Decision-maker cannot be willing to pay less than 0 for a gain in LYs

  10. Using NMB to identify factors that influence cost-effectiveness (1) It is true that: However the difference in mean benefit between the experimental (subscript 1) and control (subscript 0) inverventions can be written:

  11. Using NMB to identify factors that influence cost-effectiveness (2) We can define a NMB for each subject: We can then estimate the model, using OLS: (where t=1 if subject received new treatment, t=0 otherwise)

  12. Using NMB to identify factors that influence cost-effectiveness (3) We can then extend this framework to estimate the partial effects of other covariaates: It then becomes possible to estimate the effects of factors such as age and sex on net monetary benefit – hence on cost-effectiveness

More Related