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Epi 213 Decision and Cost-Effectiveness Analysis (DCEA)

Epi 213 Decision and Cost-Effectiveness Analysis (DCEA). Introduction & Overview 5 Jan 2012. Today. Introductions (15 min) Course staff Students Course overview (30 min) Lecture - Decision Trees (60 min) Discussion (15 min). DCEA Staff. James G. Kahn, MD, MPH. Home

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Epi 213 Decision and Cost-Effectiveness Analysis (DCEA)

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  1. Epi 213 Decision and Cost-Effectiveness Analysis (DCEA) Introduction & Overview 5 Jan 2012

  2. Today • Introductions (15 min) • Course staff • Students • Course overview (30 min) • Lecture - Decision Trees (60 min) • Discussion (15 min)

  3. DCEA Staff

  4. James G. Kahn, MD, MPH • Home • UCSF - Institute for Health Policy Studies, Dept of Epidemiology and Biostatistics, Global Health Sciences. • Mission • How can we best spend health care dollars to improve health? • Thus – projects on efficiency in intervention choice & service delivery

  5. Cost-effectiveness of Male Circumcision for HIV Prevention in South Africa

  6. GHIR2 – the dream

  7. Jose Luis Burgos, MD, MPH • Home • UCSD – Division of Global Public Health, Dept. of Medicine. • UCSD/ UABC Health Frontiers in Tijuana Project: First true Binational student run free clinic in the U.S.-Mexico Border. • Mission • How can we improve the role of economic evaluation studies in translating EB HIV/TB prevention interventions into health policy? • From Cost-Efficacy to Cost-Effectiveness

  8. First Binational Student Run Free Clinic in the U.S. Mexico Border Region

  9. CEA Results Mujer Segura Behavioral Intervention is Cost-Effective for HIV/STI Prevention 0% 10% 20% 60% 4 0.03 15 5.5 12 3.8 11 3.6 Cost effectiveness ($/QALY gained) HIV related costs not included * Per 100 person-years Burgos, et.al. PLoS One 2010

  10. Conceptual framework for evidence based HIV prevention technology transfer activities Policy & Programmatic Decision Making Quantitative Policy Analysis Scientific Information Social determinants of disease Epidemiology (including disease & risk behavior pattern, and demographics) Intervention efficacy studies Prevention services research Decision Analysis Cost, cost-effectiveness, and threshold analysis Multi-attribute utility analysis Resource allocation decision across disease areas Judgments of the affordability of HIV prevention interventions Resource allocation decision across HIV prevention activities Policy Relevant Holtgrave, 2004

  11. Next Steps: Mixed Methods approach for conducting a policy relevant cost-effectiveness analysis. Mujer Segura Implementation Project Programmatic Costs and Health Outcomes N=960 Informs Analysis Mexican Policymakers and Community Based Org. Decision-Makers Qualitative Interviews (n=40) Mujer Segura Upscale Implementation Policy Relevant Cost-Effectiveness Analysis (12 CBO’s) Informs Analysis Inform Each Other Informs Analysis Mexican Policymakers and Community Based Organizations Decision-Makers Quantitative Questionnaires (n=40)

  12. Renee Y. Hsia, MD, MSc • Home • UCSF – Department of Emergency Medicine; San Francisco General Hospital • Mission • How do we expand access to emergency care, especially for vulnerable populations? • Thus – projects on regionalization of emergency care

  13. DCEA students • TICR – MCR / ATCR – ~20 • Global Health Masters – ~20 • Translational Medicine – ~4 • Other (mainly clinical) - ~7

  14. DCEA structure • Six cycles of lecture + section: • Decision trees • Valuing health: QALYs/DALYs • Adding costs: Cost-effectiveness • Data inputs • Sensitivity analyses • Markov disease-state modeling • Sections: • Review HW (10 min) • Review student projects – 10 min each - structured summary / critique / discussion • Special topics: • Excel tutorial • HIV • Behavioral economics • Other TBD – TB, ortho

  15. DCEA student work & grading • Readings – prioritize Lecture Notes over articles • Homework / problem sets (5) • Mainly on mammography • First is open-ended, then 3 programmed (excel) • One on CEA article review • Skip cycle 4 • Value: 50 points (10 each) – late homework downgraded • Own project – DA / CEA • Design & implement simple CEA. • Start with Excel templates; ok to use other software • Each cycle, add new element (and update), feedback from mentor • By end, have complete simple DA/CEA • Typically solo; can work in pairs if add partial manuscript • Given preliminary score and chance to refine • Value: 50 points • Final exam • Optional, if needed due to problems with HW/project

  16. DCEA Mentors

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