Cost-Effectiveness Analysis in Health: A Practical Approach [3 ed.] 978-1119011262
The field's bestselling reference, updated with the latest tools, data, techniques, and the latest recommendations
235 94 41KB
English Pages 440 [484] Year 2016
Table of contents :
List of Tables, Figures, and Exhibits xi
Preface xxi
Acknowledgments xxv
About the Author xxvii
Chapter 1 Introduction to Cost-Effectiveness 1
Learning Objectives 1
Overview 1
Why Cost-Effectiveness Is Useful 2
Elements of Cost-Effectiveness Analysis 4
The Average and Incremental Cost-Effectiveness Ratio 9
Why Conduct Cost-Effectiveness Analysis? 11
The Reference Case Analysis 14
Cost-Effectiveness Analysis and Policy 17
Summary 24
Further Readings 24
References 25
Chapter 2 Principles of Cost-Effectiveness Analysis 29
Learning Objectives 29
Overview 29
The Perspective of a Cost-Effectiveness Analysis 29
Capturing Costs 33
Capturing Quality 35
Interpreting the Cost-Effectiveness Ratio 39
Types of Economic Analysis 43
Summary 48
Further Readings 49
References 49
Chapter 3 Developing a Research Project 53
Learning Objectives 53
Overview 53
Eight Steps to a Perfect Research Project 53
Developing a Research Question 55
Designing Your Analysis 64
Summary 70
Further Readings 70
References 70
Chapter 4 Working with Costs 73
Learning Objectives 73
Overview 73
Opportunity Costs 74
Identifying Costs 77
Micro-Costing and Gross Costing 80
Getting Cost Data 82
Using Diagnosis Codes 84
Adjusting Costs 86
Costs Associated with Pain and Suffering 95
Assessing the ‘‘Relevancy’’ of Cost Data 97
Other Cost Considerations 98
Summary 102
Further Readings 103
References103
Chapter 5 Probabilities and Decision Analysis Models 105
Learning Objectives 105
Overview 105
The Idea Behind Decision Analysis 105
Probabilities 109
Decision Analysis Models 114
Summary 131
Further Reading 132
References 132
Chapter 6 Calculating Life Expectancy 135
Learning Objectives 135
Overview 135
Hand-Calculating Years Gained 135
Calculating Life-Years Lost Using Markov Models 140
Summary 150
Further Readings 151
References 151
Chapter 7 Working with Health-Related Quality-of-Life Measures 153
Learning Objectives 153
Overview 153
Framework 154
Deriving HRQL Scores 158
Other Considerations and Reminders 168
Using Disability-Adjusted Life-Years 171
Summary 172
Further Readings 173
References 173
Chapter 8 Calculating QALYs 177
Learning Objectives 177
Overview 177
Using the Summation Method 178
Using the Life Table Method 180
More On Discounting 189
Issues with QALYs 191
Calculating Incremental Cost-Effectiveness 192
Disability-Adjusted Life-Year (DALY) 195
Summary 196
Further Readings 196
References 196
Chapter 9 Conducting a Sensitivity Analysis 199
Learning Objectives 199
Overview 199
Performing a Sensitivity Analysis 199
Sensitivity Analysis 201
One-Way Sensitivity Analysis 203
Two-Way Sensitivity Analysis 207
Tornado Diagram 208
Multiway Sensitivity Analysis 210
Summary 222
Further Readings 222
References 223
Chapter 10 Preparing Your Study for Publication 225
Learning Objectives 225
Overview 225
Content and Structure of Cost-Effectiveness Articles 225
Title and Abstract 230
Introduction 231
Methods 233
Results 235
Discussion 238
Other 238
Technical Appendix 239
Figures and Illustrations 240
Summary 240
Further Reading 241
References 241
Chapter 11 Basic Concepts in Epidemiology and Application to Cost-Effectiveness Analysis 243
Learning Objectives 243
Overview 243
Review of Incidence 244
Understanding Error 252
Managing Error in Cost-Effectiveness Analysis 255
Calculating Weighted Means 261
Evaluating Study Limitations 263
Summary 274
Further Readings 275
References 276
Chapter 12 Finding the Data You Need 279
Learning Objectives 279
Overview 279
Finding Data in the Medical Literature 279
Grading Published Data 281
Using Electronic Datasets 282
Data Extraction Tools 290
Using Unpublished Data 293
Using Expert Opinion 294
Organizing Your Data 295
Summary 295
Further Readings 296
References 296
Chapter 13 A Worked Example 299
Learning Objectives 299
Overview 299
Helping Students Learn 299
Laboratory Exercise One: Building a Markov Tree 300
Laboratory Exercise Two: Comparing Interventions 320
Laboratory Exercise Three: The Cost-Effectiveness of Health Insurance 333
Laboratory Exercise Four: Sensitivity Analysis 344
Summary 358
Appendix A Answer Key to Exercises 359
Appendix B Life Expectancy and Quality-Adjusted Life Expectancy Tables 375
Appendix C EQ-5D-5L Health Questionnaire (English Version for the United States) 379
Appendix D Diagnosis, Charges, Medicare Reimbursement, Average Length of Stay, and Cost-to-Charge Ratio by Diagnosis-Related Groups, 2011 383
Glossary 419
Index 431
List of Tables, Figures, and Exhibits xi
Preface xxi
Acknowledgments xxv
About the Author xxvii
Chapter 1 Introduction to Cost-Effectiveness 1
Learning Objectives 1
Overview 1
Why Cost-Effectiveness Is Useful 2
Elements of Cost-Effectiveness Analysis 4
The Average and Incremental Cost-Effectiveness Ratio 9
Why Conduct Cost-Effectiveness Analysis? 11
The Reference Case Analysis 14
Cost-Effectiveness Analysis and Policy 17
Summary 24
Further Readings 24
References 25
Chapter 2 Principles of Cost-Effectiveness Analysis 29
Learning Objectives 29
Overview 29
The Perspective of a Cost-Effectiveness Analysis 29
Capturing Costs 33
Capturing Quality 35
Interpreting the Cost-Effectiveness Ratio 39
Types of Economic Analysis 43
Summary 48
Further Readings 49
References 49
Chapter 3 Developing a Research Project 53
Learning Objectives 53
Overview 53
Eight Steps to a Perfect Research Project 53
Developing a Research Question 55
Designing Your Analysis 64
Summary 70
Further Readings 70
References 70
Chapter 4 Working with Costs 73
Learning Objectives 73
Overview 73
Opportunity Costs 74
Identifying Costs 77
Micro-Costing and Gross Costing 80
Getting Cost Data 82
Using Diagnosis Codes 84
Adjusting Costs 86
Costs Associated with Pain and Suffering 95
Assessing the ‘‘Relevancy’’ of Cost Data 97
Other Cost Considerations 98
Summary 102
Further Readings 103
References103
Chapter 5 Probabilities and Decision Analysis Models 105
Learning Objectives 105
Overview 105
The Idea Behind Decision Analysis 105
Probabilities 109
Decision Analysis Models 114
Summary 131
Further Reading 132
References 132
Chapter 6 Calculating Life Expectancy 135
Learning Objectives 135
Overview 135
Hand-Calculating Years Gained 135
Calculating Life-Years Lost Using Markov Models 140
Summary 150
Further Readings 151
References 151
Chapter 7 Working with Health-Related Quality-of-Life Measures 153
Learning Objectives 153
Overview 153
Framework 154
Deriving HRQL Scores 158
Other Considerations and Reminders 168
Using Disability-Adjusted Life-Years 171
Summary 172
Further Readings 173
References 173
Chapter 8 Calculating QALYs 177
Learning Objectives 177
Overview 177
Using the Summation Method 178
Using the Life Table Method 180
More On Discounting 189
Issues with QALYs 191
Calculating Incremental Cost-Effectiveness 192
Disability-Adjusted Life-Year (DALY) 195
Summary 196
Further Readings 196
References 196
Chapter 9 Conducting a Sensitivity Analysis 199
Learning Objectives 199
Overview 199
Performing a Sensitivity Analysis 199
Sensitivity Analysis 201
One-Way Sensitivity Analysis 203
Two-Way Sensitivity Analysis 207
Tornado Diagram 208
Multiway Sensitivity Analysis 210
Summary 222
Further Readings 222
References 223
Chapter 10 Preparing Your Study for Publication 225
Learning Objectives 225
Overview 225
Content and Structure of Cost-Effectiveness Articles 225
Title and Abstract 230
Introduction 231
Methods 233
Results 235
Discussion 238
Other 238
Technical Appendix 239
Figures and Illustrations 240
Summary 240
Further Reading 241
References 241
Chapter 11 Basic Concepts in Epidemiology and Application to Cost-Effectiveness Analysis 243
Learning Objectives 243
Overview 243
Review of Incidence 244
Understanding Error 252
Managing Error in Cost-Effectiveness Analysis 255
Calculating Weighted Means 261
Evaluating Study Limitations 263
Summary 274
Further Readings 275
References 276
Chapter 12 Finding the Data You Need 279
Learning Objectives 279
Overview 279
Finding Data in the Medical Literature 279
Grading Published Data 281
Using Electronic Datasets 282
Data Extraction Tools 290
Using Unpublished Data 293
Using Expert Opinion 294
Organizing Your Data 295
Summary 295
Further Readings 296
References 296
Chapter 13 A Worked Example 299
Learning Objectives 299
Overview 299
Helping Students Learn 299
Laboratory Exercise One: Building a Markov Tree 300
Laboratory Exercise Two: Comparing Interventions 320
Laboratory Exercise Three: The Cost-Effectiveness of Health Insurance 333
Laboratory Exercise Four: Sensitivity Analysis 344
Summary 358
Appendix A Answer Key to Exercises 359
Appendix B Life Expectancy and Quality-Adjusted Life Expectancy Tables 375
Appendix C EQ-5D-5L Health Questionnaire (English Version for the United States) 379
Appendix D Diagnosis, Charges, Medicare Reimbursement, Average Length of Stay, and Cost-to-Charge Ratio by Diagnosis-Related Groups, 2011 383
Glossary 419
Index 431
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