1. Economic evaluation of health programmes Department of Epidemiology, Biostatistics and Occupational Health Class no. 25: Dec 1, 2008

2. Plan of class  Discussion of assignment no 4  Using PBMA; Multi-criteria decision analysis  Course wrap-up

3. Question 1: Additional assumptions  If treatment at ER is unsuccessful, and only if it is unsuccessful, person is hospitalized – prob = 0.002  Following relief (however obtained), 48 hours elapse until a new attack may occur  If recurrence occurs, it does so according to probabilities previously specified

4. Comments on question 1  24 pathways (see diagrams)  Taking time into account – see spreadsheet  Prorate cost of hospitalization?  Atypical decision tree analysis:  Time built-in; utility “payoffs” depend on relative time duration in different states  See example next slide

5. Example from which assignment drawn: Briggs, Claxton, Sculpher, Decision Modelling for Health Economic Evaluation, Oxford, 2006

6. Comments on question 2  Straightforward calculations  Small difference in transition probabilities + most people staying well leads to small difference in utility/QALYs; cost difference driven by difference in cost of meds  Best modelling approach depends greatly on extent to which past events influence likelihood of future ones

7. Using Programme Budgeting and Marginal Analysis and Multi-criteria decision analysis

8. The problem  NICE’s problem described last time  Cost-effectiveness insufficient, scale, regional differences and other factors affect true opportunity cost  Problem magnified at local level  Even if you have national guidelines, not clear just how to implement them at the local level  Many possible criteria – how to weigh them?

9. Source: Peacock and Ruta, 2006

12. Four types of analysis  Evidence-based medicine  What works?  Burden of disease analysis  Cost-effectiveness analysis  Equity analysis  Distributional impact – to what extent do the poor or other disadvantaged groups benefit compared to better-off groups?  Types of analysis developed separately from each other

13. Ad hoc priority setting Source: Baltussen and Niessen, 2006 Intuition is inadequate to process all this information rationally

14. Rational priority setting Methods exist to analyze this information systematically Source: Baltussen and Niessen, 2006

16. Analysing a performance matrix  Qualitative  E.g., look for dominance  Quantitative  Construct scales to represent preferences for consequences (so programs can be compared dimension by dimension)  Weight the scales for relative importance  Calculate weighted averages across scales Often done using linear additive model if reasonable to think criteria preferentially independent of each other

17. Source: Baltussen and Niessen, 2006

18. Questions for discussion  What are the key ideas that struck you about the course? Anything that really interested you?  What topics more effectively taught, what less well? What made the difference?  Comments on assignments? Nature and quantity of work outside class?