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GW4546M Health Technology Assessment
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Summary HTALecture 1 .......................................................................................................................................................... 2
Lecture 2: Medical costs and Discounting ......................................................................................................... 7
Lecture 3 non medical costs in economic evaluation of health care ............................................................... 17
Lecture 4: quality of life part A ....................................................................................................................... 26
Lecture 5 part 1 Measuring health outcomes ................................................................................................. 32
Part 2: measuring health outcomes ................................................................................................................. 33
Part 3: how to select the most appropriate method for measuring quality of life ........................................... 36
Part 4: assessing the performance of quality-of-life instruments .................................................................... 38
Lecture 6 ........................................................................................................................................................ 43
Lecture 7 theoretical foundations .................................................................................................................. 52
Lecture 8 Dealing with uncertainties in HE models ......................................................................................... 59
Lecture 9: Beyond Qaly ................................................................................................................................. 68
, Lecture 1
What will you learn In this course?
1- How to conduct an economic evaluation
2- To understand and recognize (international) differences in HTA methodology
3- To assess the quality of an economic evaluation and interpret the results
4- To understand the relationship between HTA and policy
Most of the money in health care is public money
Resources are scare→ we can only spend money once
• Money spent on technology A cannot spent on a technology B
• Money spent on health care cannot be spent on education or infrastructure etc.
Breast cancer medicine Treatment cost Treatment effect
Incidence 5500 per year in UK • 200 per month Live 6-12 months longer
20% is aggressive 24000 per year
Question to us
• Would you reimburse the drug?
Medicine for Duchene ( very rare) Treatment cost Treatment effect
Incidence 60-70 per year in UK 220000 per year Delay the loss of walking for
up to seven years
6-0 mutations relevant for the drug
Why HTA?
• Health care expenditures increase
- is this a problem? → yes because we can’t spend endless of money at Health care.
There are also other spending’s of public area
- what happens if we reimburse every treatment
- positive + negative consequences
if you must made choices in health care it’s better to make informed choices
• important advisory tool → make transparent and unbiased decisions
• compulsory for deciding on reimbursement in many countries
• assure value for money
definition HTA
• HTA is systematic evaluation of properties effects and or impact of health
technologies and interventions. It covers both the direct, intended consequences of
technologies and interventions and their indirect unintended consequences
Unintended consequences = if you have cancer you also can get hart problems too
Economic evaluation is usually the core
→ compare two alternative regarding costs and benefits
,Economic evaluations:
Economic evaluations provide insight costs and effects of
• (new) interventions
• Compared with existing interventions ( this are alternatives)
→ for example is it worth it to go to the campus to follow the lecture of is it better to
stay home and follow it online? Shall I buy this water in the supermarket or is it not
worth it? You make an decision how much does it give me and what are the costs
Economic evaluations are everywhere. In this lecture we will go threw al the 6 points.
Step 1 Design study
a) Perspective- who is going to pay?
Two dominant perspectives
1- Health care perspective
• All Costs and effects are falling on health care budget
• For example hospital costs, primary care physicians, nurses cost etc
2- Social perspective
• All relevant costs and effects
• For example out of pocket → not under the health care budget
• And travels costs to the hospital
→ but also patients or health insurer perspective
Perspective determines which costs and effects to include in the assessment.
Those 2 are dominant but you also have from a patients perspective and insurance
perspectives. For example, stop smoking programs for their costumers
b) Choice of comparator (this is very relevant)
• We recommend the most efficient alternative → how is this treatment compared to
the most effective alternative. If you do a study with a nokia500 of course the iPhone
5 is better. But if you do a study with an iPhone 5 and iPhone 12 then the iPhone 12
is better.
• Standard treatment
• Consider no treatment → if there is a treatment but it’s not really relevant then you
can also compare your study treatment with no treatment. Because it makes no
sense to compare it with a bad treatment.
• Placebo not preferred → not a good alternatief.
, c) Different type of analyses
1- Only costs
• Costs minimization analysis (CMA) → if you know for sure that the outcomes are the
same.
• Effects are equal focus on cost
• You need to choose one of the 3 medicins, they are all the same only the price is
different. You choose the one who is the cheapest
2- Cost and effects in monetary terms
• Cost benefit analysis (CBA) → present the outcomes in monetary terms. We can do
this with attaching it with certain values. You have real outcomes. How much do you
need to pay to avoid an hart attack.
• WTP and Human capital
• Cost of each treatment ivm the value which of the 3 treatments is cost/ value
/benefit basted the best
3- Cost in monetary terms, effects in natural units
• Cost effectiveness analysis (CEA)
4- Costs in monetary terms, effects in Qaly’s
• Cost utility analysis we compare this over the diseases ( CUA)
• Qualy 0-1
d) Time horizon
• All consequences must be taken into account
• Lifetime horizon → we can take all consequences into an account . if there is a
treatment that make life longer from 75 to 76 years we should take into an account
everything that happen before that. You need to extrapolate the data ( schatten van
waarde die buiten het bereikv an de set zijn gevallen)
• How to do so?
- RCT
- Observational study
- Model (cohort or individual patient model)
- Combination
Casus obesity and overweight (WHO)
• Worldwide obesity has more than doubled since 1980
• In 2014 more than 1.9 billion adults (39%) were overweight. 600 million (13%) were
obese
• 41 million children under the age of 5 were overweight or obese in 2014
• Obesity is preventable
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