Cost Effectiveness and Resource Allocation - Latest Articles

The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations

Paul van Gils — 2010-07-06T00:00:00Z

Background: Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse.MethodTo investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies. Results: The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%. Conclusions: The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.

Cost-utility of Intravenous Immunoglobulin (IVIG) compared with corticosteroids for the treatment of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in Canada

Gord Blackhouse — 2010-06-17T00:00:00Z

ObjectivesIntravenous immunoglobulin (IVIG) has demonstrated improvement in chronic inflammatory demyelinating polyneuropathy (CIDP) patients in placebo controlled trials. However, IVIG is also much more expensive than alternative treatments such as corticosteroids. The objective of the paper is to evaluate, from a Canadian perspective, the cost-effectiveness of IVIG compared to corticosteroid treatment of CIDP. Methods: A markov model was used to evaluate the costs and QALYs for IVIG and corticosteroids over 5 years of treatment for CIDP. Patients initially responding to IVIG could remain a responder or relapse every 12 week model cycle. Non-responding IVIG patients were assumed to be switched to corticosteroids. Patients on corticosteroids were at risk of a number of adverse events (fracture, diabetes, glaucoma, cataract, serious infection) in each cycle. Results: Over the 5 year time horizon, the model estimated the incremental costs and QALYs of IVIG treatment compared to corticosteroid treatment to be $124,065 and 0.177 respectively. The incremental cost per QALY gained of IVIG was estimated to be $687,287. The cost per QALY of IVIG was sensitive to the assumptions regarding frequency and dosing of maintenance IVIG. Conclusions: Based on common willingness to pay thresholds, IVIG would not be perceived as a cost effective treatment for CIDP.

Cost-effectiveness analysis of clinical specialist outreach as compared to referral system in Ethiopia: an economic evaluation

Yibeltal Kifle — 2010-06-11T00:00:00Z

Background: In countries with scarce specialized Human resource for health, patients are usually referred. The other alternative has been mobilizing specialists, clinical specialist outreach. This study examines whether clinical specialist outreach is a cost effective way of using scarce health expertise to provide specialist care as compared to provision of such services through referral system in Ethiopia. Methods: A cross-sectional study on four purposively selected regional hospitals and three central referral hospitals was conducted from Feb 4-24, 2009. The perspective of analysis was societal covering analytic horizon and time frame from 1 April 2007 to 31 Dec 2008. Data were collected using interview of specialists, project focal persons, patients and review of records. To ensure the propriety standards of evaluation, Ethical clearance was obtained from Jimma University. Results: It was found that 532 patients were operated at outreach hospitals in 125 specialist days. The unit cost of surgical procedures was found to be ETB 4,499.43. On the other hand, if the 125 clinical specialist days were spent to serve patients referred from zonal and regional hospitals at central referral hospitals, 438 patients could have been served. And the unit cost of surgical procedures through referral would have been ETB 6,523.27 per patient. This makes clinical specialist outreach 1.45 times more cost effective way of using scarce clinical specialists' time as compared to referral system. Conclusion: Clinical specialist outreach is a cost effective and cost saving way of spending clinical specialists' time as compared to provision of similar services through referral system.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

Khurshid Alam — 2010-06-09T00:00:00Z

Background: Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG) targets the financial sustainability of such facilities is crucial. Methods: The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value). Sensitivity analysis was done using 3% discount rate. Results: The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion: The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase utilization, efficient planning, resource allocation and their optimum use. It also requires controlling variable costs and preventing any wastage of resources.

Cost-effectiveness of a pressure ulcer quality collaborative

Peter Makai — 2010-06-01T00:00:00Z

Background: A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. Methods: We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sustained, (2) partially sustained, and (3) completely sustained. Results: Incidence of PUs decreased from 15% to 4.5% for the 88 patients. Prevalence decreased from 38.6% to 22.7%. Average Quality of Life (Qol) of patients increased by 0.02 Quality Adjusted Life Years (QALY)s in two years; healthcare costs increased by €2000 per patient; the Incremental Cost-effectiveness Ratio (ICER) was between 78,500 and 131,000 depending on whether the changes in incidence and prevalence of PU were sustained. Conclusions: During the QIC PU incidence and prevalence significantly declined. When compared to standard PU care, the QIC was probably more costly and more effective in the short run, but its long-term cost-effectiveness is questionable. The QIC can only be cost-effective if the changes in incidence and prevalence of PU are sustained.

Cost-effectiveness implications of GP intervention to promote physical activity: evidence from Perth, Australia

Anura Amarasinghe — 2010-05-13T00:00:00Z

Background: Physical inactivity is a major risk factor for many chronic diseases including diabetes, cardiovascular diseases and some cancers. It is estimated that, in Australia, physical inactivity contributes to 13,500 annual deaths and incurs an annual cost of AU$ 21 billion to the health care system. The cost of physical inactivity to the Western Australian (WA) economy is estimated to be about AU$ 2.1 billion. Increased burden of physical inactivity has motivated health professionals to seek cost effective intervention to promote physical activity. One such strategy is encouraging general practitioners (GPs) to advocate physical activity to the patients who are at high risk of developing chronic diseases associated with physical inactivity. This study intends to investigate the cost-effectiveness of a subsidy program for GP advice to promote physical activity.MethodologyThe percentage of population that could potentially move from insufficiently active to sufficiently active, on GP advice was drawn from the Western Australian (WA) Premier's Physical Activity Taskforce (PATF) survey in 2006. Population impact fractions (PIF) for diseases attributable to physical inactivity together with disability adjusted life years (DALYs) and health care expenditure were used to estimate the net cost of intervention for varying subsidies. Cost-effectiveness of subsidy programs were evaluated in terms of cost per DALY saved at different compliance rates. Results: With a 50% adherence to GP advice, an annual health care cost of AU$ 24 million could be potentially saved to the WA economy. A DALY can be saved at a cost of AU $ 11,000 with a AU$ 25 subsidy at a 50% compliance rate. Cost effectiveness of such a subsidy program decreases at higher subsidy and lower compliance rates. Conclusion: Implementing a subsidy for GP advice could potentially reduce the burden of physical inactivity. However, the cost-effectiveness of a subsidy program for GP advice depends on the percentage of population who comply with GP advice.

Measuring the time costs of exercise: a proposed measuring method and a pilot study

Lars Hagberg — 2010-05-11T00:00:00Z

Background: The cost of time spent on exercise is an important factor in societal-perspective health economic analyses of interventions aimed at promoting physical activity. However, there are no existing measuring methods for estimating time costs. The aim of this article is to describe a way to measure the costs of time spent on physical activity. We propose a model for measuring these time costs, and present the results of a pilot study applying this model to different groups of exercisers. Methods: We began this investigation by developing a model for measuring the time spent on exercise, based on the most important theoretical frameworks for valuing time. In the model, the value of utility in anticipation (expected health benefits) of performing exercise is expressed in terms of health-related quality of life. With this approach, the cost of the time spent on exercise is defined as the value of utility in use of leisure activity forgone minus the value of utility in use of exercise. Utility in use for exercise is valued in comparison with utility in use for leisure activity forgone and utility in use for work.To put the model into practice, we developed a questionnaire with the aim of investigating the valuations made by exercisers, and applied this questionnaire among more experienced and less experienced exercisers. Results: Less experienced exercisers valued the time spent on exercise as being equal to 26% of net wages, while more experienced exercisers valued this time at 7% of net wages (p < 0.001). The higher time costs seen among the less experienced exercisers correlated to a less positive experience of exercise and a more positive experience of the lost leisure activity. There was a significant inverse correlation between the costs of time spent on exercise, and the frequency and duration of regular exercise. Conclusion: The time spent on exercise is an important factor in interventions aimed at promoting physical activity, and should be taken into consideration in cost-effectiveness analyses. The proposed model for measuring the costs of the time spent on exercise seems to be a better method than the previously-used assumptions of time costs.

Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

Rosanna Tarricone — 2010-05-10T00:00:00Z

ObjectivesThe aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI) and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass) infusion containers. Methods: A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases) and patients without CLABSI (controls) were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days) associated with the two infusion containers. Results: A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143); 56% of the cases and 57% of the controls were females (p = 0.922). The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p < 0.001). Overall, the mean total costs of patients with and without CLABSI were € 18,241 and € 9,087, respectively (p < 0.001). On average, the extra cost for drugs was € 843 (p < 0.001), for supplies € 133 (p = 0.116), for lab tests € 171 (p < 0.001), and for specialist visits € 15 (p = 0.019). The mean extra cost for hospital stay (overhead) was € 7,180 (p < 0.001). The closed infusion container was a dominant strategy. It resulted in lower CLABSI rates (3.5 vs. 8.2 CLABSIs per 1000 central line days for closed vs. open infusion container) without any significant difference in total production costs. The higher acquisition cost of the closed infusion container was offset by savings incurred in other phases of production, especially waste management. Conclusions: CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

A health economic model for evaluating a vaccine for the prevention of herpes zoster and post-herpetic neuralgia in the UK

Lee Moore — 2010-04-30T00:00:00Z

Background: A live-attenuated vaccine aimed at preventing herpes zoster (HZ) and its main complication, post-herpetic neuralgia (PHN) is available in Europe for immunocompetent adults aged 50 years and more. The study objective is to assess the cost effectiveness of a vaccination program for this population in the UK. Methods: A state-transition Markov model has been developed to simulate the natural history of HZ and PHN and to estimate the lifetime effects of vaccination in the UK. Several health states are defined including good health, HZ, PHN, and death. HZ and PHN health states are further divided to reflect pain severity. Results: The model predicts that a vaccination strategy for those aged over 50 years would lead to an incremental cost-effectiveness ratio of £13,077 per QALY gained from the NHS perspective, when compared to the current strategy of no vaccination. Age-group analyses show that the lowest ICERs (£10,984 and £10,275 for NHS) are observed when vaccinating people between 60-64 and 65-69 years of age. Sensitivity analyses showed that results are sensitive to the duration of vaccine protection, discount rate, utility decrements and pain severity split used. Conclusions: Using the commonly accepted threshold of £30,000 per QALY gained in the UK, most scenarios of vaccination programmes preventing HZ and PHN, including the potential use of a repeat dose, may be considered cost-effective by the NHS, especially within the 60 to 69 age-groups.

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom

Oliver Rivero-Arias — 2010-04-27T00:00:00Z

Background: To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective. Methods: All UK residents in 2005 with aSAH (International Classification of Diseases 10th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death. Results: A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually. Conclusion: The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.