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Lecture 5 6 Chapter 6 Students S21

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26 views10 pages

Lecture 5 6 Chapter 6 Students S21

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mariamkhaledd777
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© © All Rights Reserved
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6/1/2021

Chapter Six
Cost Utility Analysis

What is Cost Utility Analysis


• Takes into account patient
preferences (utilities).

Both quality
(morbidity) &
quantity
(mortality) of
life are
considered.

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What is Cost Utility Analysis


• Some consider it a special case of CEA, where
the outcome is measured in special unit (QALYs).

Advantages
Different types of diseases and health
outcomes can be compared (Unlike CEA)
Does NOT have to search for monetary values
for morbidity or mortality (Unlike CBA)

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Disadvantage

Difficult to determine an accurate


utility or preference weight value.

Can we use CUA for


 Two treatments that extend life for different number
of years with different side effects/ qualities?
Yes
 Two treatments that extend life for different number
of years with very similar side effects/qualities?
No need for quality adjustments.
 Two treatments that extend life for same number of
years with different qualities?
Yes
 Treatments and outcomes that are very different e.g.
heart disease versus prenatal care?
Yes

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When is CUA needed?


• Utility adjustment might NOT be crucial: when two
drugs have different number of years of lives saved
and same quality.

• However, in cancer treatment for example, the


length of life & quality of life are different.

• Some treatments has no effect on # of lived years


but affects the quality of life. CUA is best used e.g.
Hearing loss, Seasonal allergies….

Steps to Calculate QALYs


I. Develop a DESCRIPTION of each disease state or
condition of interest.

II. Choose a METHOD for determining utilities.

III. Choose SUBJECTS who will determine utilities.

IV. Sum the PRODUCT of utility scores by the length


of life for each option to obtain QALYs.

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Step I. Develop a Description


• Concisely depict the usual health effects expected
from the disease state or condition.
• Should be formulated in layman’s language
• Should include:
• The amount of pain or discomfort and any
restrictions on activities (Physiology of disease or
intervention).
• The time it may take for treatment.
• Possible changes in health perceptions (worry or
concern) and any mental changes (Psychological
factors).

Example: Description of Hospital-Based


Kidney Dialysis
• You often feel tired and sluggish.
• A piece of tubing has been inserted into your arm or leg,
which may restrict your movement.
• There is no severe pain but rather chronic discomfort.
• You must go to the hospital twice a week for 6 hours per
visit (TIME).
• You must follow a strict diet (low salt, little meat, no
alcohol).
• Many people become depressed because of the
nuisances and restrictions, and some feel they are being
kept alive by a machine (PSYCHOLOGICAL).
• Remember Wales in UK.

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Example: Description of Diabetic


Retinopathy
• You have an illness that affects your blood sugar levels.
• You need to take medication every day and test your
blood.
• If your blood sugar level drops below a certain level, you
are in danger of becoming seriously ill.
• You sometimes experience blurry vision, and you have
some problems with your central vision.
• You have trouble reading, especially fine or small print and
sometimes have trouble seeing things clearly at night.
• You feel anxious that your sight will get worse in the future.
• You feel somewhat depressed about your level of vision
and the risk that you might develop further complications.

The BETTER the


Description the MORE
ACCURATE the Results

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Step II. Choose a Method for


Determining Utilities
Methods for determining
Utilities

Direct Elicitation Indirect Elicitation

Chapter 8
Rating Scale Standard Time Tradeoff
(HRQoL
(RS) Gamble (SG) (TTO)
questionnaires)

For each of these methods, a disease state(s) or condition(s) is/are


described to subjects who help determine where these disease
states/conditions fall between 0.0 (dead) and 1.0 (perfect health).

A. Rating Scale (RS)


100 (1.0 ) - Perfect health

90 (0.9 ) - Mild Allergies

80 (0.8 )

70 (0.7 ) - Broken arm/ leg

60 (0.6 ) - Hospital dialysis

50 (0.5 )

40 (0.4 ) - Severe Angina

30 (0.3 )

20 (0.2 )

10 (0.1 ) - Coma ( 1 year)

0 (0.0 ) - Dead

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B. Standard Gamble (SG)

Healthy
Alternative 1

Dead

Alternative 2

Diseased State

Utility score is P at the point of indifference

C. Time Tradeoff (TTO)


Utility Value
Not suitable for all
types of diseases

Alternative 1
Healthy 1

Alternative 2
Disease State

Dead 0 Time
X T

Utility score = X/T

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Comparison of the Three Methods


Point of Rating Scale Standard Time Tradeoff
Comparison Gambling
Property Many diseases can Few conditions Few conditions
be described can be cured to can be cured to
normal health normal health

Complexity Easily done Has to be done Has to be done


through face to face for face to face for
questionnaires titration titration
Time Factor Not incorporated Not incorporated Incorporated
Scores Usually the least More than RS Less than SG (In-
between)

Algorithms are being developed to convert one method to another

Step III. Choose Subjects who will Determine Utilities

Subjects Advantage Disadvantage


Patients Knowledge of the Biased to their own or
disease alternatively adapted!
Patient may be a minor or
with a disabling disease
(parent/ caregiver)
HC Professionals Knowledge of the Underestimate the patient
disease agony/ discomfort, etc…
Society Correct population Poor knowledge of the
(health-economist disease
point of view) Hardest and most
expensive to reach.

Literature: Health care professionals is the most widely used


(knowledge of the disease and accessible for interviews).

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Step IV. Multiply utilities by the length of life in


each option to get QALYs

THANK YOU 

10

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