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Interactive session design cost effectiveness

Interactive session design cost effectiveness. Jan J. v. Busschbach, Ph.D. Erasmus MC Institute for Medical Psychology and Psychotherapy PO Box 1738 3000 DR Rotterdam +31 10 4087807 J.vanbusschbach@erasmusmc.nl Psychotherapeutic centre 'De Viersprong’

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Interactive session design cost effectiveness

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  1. Interactive session design cost effectiveness • Jan J. v. Busschbach, Ph.D. • Erasmus MC • Institute for Medical Psychology and PsychotherapyPO Box 17383000 DR Rotterdam+31 10 4087807J.vanbusschbach@erasmusmc.nl • Psychotherapeutic centre 'De Viersprong’ • PO Box 74660 AA Halsteren+ 31 164 632200Jan.Busschbach@deviersprong.nl • Presentations can be found at • http://www.xs4all.nl/~jannetvb/busschbach/

  2. Questions to be solved; • Who is the audience? • Who’s perspective? • Should we evaluated at all? • What are the costs? • What are the effects? • How do effects relate to the costs in practice? • Model • Who to interpret the cost effectiveness ratio?

  3. The societal perspective • Standard in health economics • Determine cost (and effects) from the societal viewpoint • Resource used by all parties concerned • The cost for society as a whole • No matter who paying • Other perspectives are possible • Insurance, government, hospital, patient, industry, doctor

  4. When to evaluated?

  5. Tariffs • Cutback operation, correction of anus anterior • Small operation • Halve hour • Tariff: 1571 Euro • Posterior Saggital Anorectoplasty (PSARP) • Large operation • 3 to 5 hours • Tariff: 374 Euro

  6. Cost price investigations • Measure only volumes of major costs drivers • Estimated “real market prices” • One should include all resources used • The societal perspective • Shadow pricing • Tariffs are only used in health economics • If they are a reasonable accurate indication of the resources used • If they are a small proportion of the total costs • If they volumes do not contribute to the incremental costs • (the difference between to alternative programs)

  7. We are in need of uni-dimensional effects • For instance: • $ 10,000 .- 1 hip transplantation • $ 15,000 ,- 1 wheelchair • Costs can be compared • Are uni-dimensionaal • Effects are less easy to compare • Effects are multi-dimensional • How to make the effects also uni-dimensional?

  8. How to make the effects uni-dimensional? • Three methods • Cost Benefit Analysis • Express effects in money • Cost Effectiveness Analysis • Focus on one effect • Cost per QALY Analysis (Utility) • QALY

  9. QALY league table

  10. Visual Analogue Scale Normal health • VAS • Also called category scaling • From psychological research • “How is your quality of life today ?” • “X” marks the spot • Response in centimeters • Rescale to [0..1] • Different anchor point possible: • Normal health (1.0) versus dead (0.0) • Best imaginable health versusworse imaginable health X Dead

  11. 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

  12. The EuroQol EQ-5D • MOBILITY • I have no problems in walking about • I have some problems in walking about • I am confined to bed • SELF-CARE • I have no problems with self-care • I have some problems washing or dressing myself • I am unable to wash or dress myself • USUAL ACTIVITIES (e.g. work, study, housework family or leisure activities) • I have no problems with performing my usual activities • I have some problems with performing my usual activities • I am unable to perform my usual activities • PAIN/DISCOMFORT • I have no pain or discomfort • I have moderate pain or discomfort • I have extreme pain or discomfort • ANXIETY/DEPRESSION • I am not anxious or depressed • I am moderately anxious or depressed • I am extremely anxious or depressed

  13. Describe health states Have values from the general public Rosser QWB 15D HUI Mark 2 HUI Mark 3 EuroQol EQ-5D Validated Questionnaires

  14. Patient Perspective

  15. The Societal Perspective

  16. How to get these societal values? • Patient fills in questionnaire • Choose the value function from the literature • Calculate societal value COMPUTE MVH_A1 = 1. VARIABLE LABELS MVH_A1 'York A1 tariff'. DO IF (NVALID(mo, sc, ua, pd, ad) < 5 ). RECODE MVH_A1 (1 = SYSMIS). END IF. IF (MAX(mo, sc, ua, pd, ad) > 1) MVH_A1 = MVH_A1 -.081. IF (mo = 2) MVH_A1 = MVH_A1 - .069. IF (mo = 3) MVH_A1 = MVH_A1 - .314. IF (sc = 2) MVH_A1 = MVH_A1 - .104. IF (sc = 3) MVH_A1 = MVH_A1 - .214. IF (ua = 2) MVH_A1 = MVH_A1 - .036. IF (ua = 3) MVH_A1 = MVH_A1 - .094. IF (pd = 2) MVH_A1 = MVH_A1 - .123. IF (pd = 3) MVH_A1 = MVH_A1 - .386. IF (ad = 2) MVH_A1 = MVH_A1 - .071. IF (ad = 3) MVH_A1 = MVH_A1 - .236. IF (MAX(mo, sc, ua, pd, ad) > 2) MVH_A1 = MVH_A1 - .269.

  17. An example of a value function * SPSS syntax Dolan 1997, Medical Care, 1997;35:1095-108. * mo = mobility, sc= self care, ua = usual activities, pd = pain & discomfort , ad = anxiety and depression. COMPUTE MVH_A1 = 1. VARIABLE LABELS MVH_A1 'York A1 tariff'. DO IF (NVALID(mo, sc, ua, pd, ad) < 5 ). RECODE MVH_A1 (1 = SYSMIS). END IF. IF (MAX(mo, sc, ua, pd, ad) > 1) MVH_A1 = MVH_A1 -.081. IF (mo = 2) MVH_A1 = MVH_A1 - .069. IF (mo = 3) MVH_A1 = MVH_A1 - .314. IF (sc = 2) MVH_A1 = MVH_A1 - .104. IF (sc = 3) MVH_A1 = MVH_A1 - .214. IF (ua = 2) MVH_A1 = MVH_A1 - .036. IF (ua = 3) MVH_A1 = MVH_A1 - .094. IF (pd = 2) MVH_A1 = MVH_A1 - .123. IF (pd = 3) MVH_A1 = MVH_A1 - .386. IF (ad = 2) MVH_A1 = MVH_A1 - .071. IF (ad = 3) MVH_A1 = MVH_A1 - .236. IF (MAX(mo, sc, ua, pd, ad) > 2) MVH_A1 = MVH_A1 - .269.

  18. Some values • Broken arm • 12211 • no problems in walking about • some problems washing or dressing • some problems with performing usual activities • no pain or discomfort • not anxious or depressed • Societal value = 0.779

  19. Some values • Broken hip • 22222 • some problems in walking about • some problems washing or dressing • some problems with performing usual activities • moderate pain or discomfort • moderately anxious or depressed • Societal value = 0.516

  20. Clinical research Does it work? Efficacy Perfect patient No co morbidity Randomized Clinical Trial Controlled conditions Outcome research Does it work in practice Effectiveness Every day patient Normal co morbidity Trials in a naturalistic setting Real life conditions Outcome Research

  21. Subject homogeneity Double blind Placebo comparison Forced compliance Fixed procedures High motivation Representativeness Open treatment Usual care Real compliance Flexible procedure Daily motivation Trial versus Clinical Practise

  22. Validity High internal Low external Increase validity by Search for large deviations of practice Model outcomes to practice Modelling Use trial effect Add external elements Validity Log internal High external Increase validity by Search for causal relations Model outcomes to new situation Modelling Use natural history Add effect Trial versus Clinical Practise

  23. Modelling depression Cure Depressive patient Sex Age Number of relapses Duration of illness suicide Natural death Still depressive

  24. Books • Oostenbrink, J. B., M. A. Koopmanschap, et al. • "Handleiding voor Kostenonderzoek. Methoden en Richtlijnprijzen voor Economische Evaluaties in de Gezondheidszorg.” 2000, College voor Zorgverzekeringen • Rutten-van Mölken MPMH, Busschbach JJV, Rutten FFH. • Van Kosten tot Effecten: Een Handleiding voor Evaluatiesstudies in de Gezondheidszorg. Elsevier Gezondheidszorg, Maassen, ISBN: 90 352 2281 4. Zomer 2000

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