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College aantekeningen Health technology Assessment (GW4546M)
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HTA EXAMHTA is the systematic evaluation of properties, effects and impacts of health
technologies and intervention. It covers both direct, intended consequences of
technologies and intervention and their indirect, unintended consequences.
The majority of healthcare expenditure is publicly financed, all expenditures are
increasing due to the increasing number of technologies that come available. Resources
are scarce, we can only spend money once. There are competing expenditures
(education, infrastructure).
- HTA is an important advisory tool to make informed choices. The decisions must
be unbiased and transparent, assure value for money and is compulsory for
deciding on reimbursement in many countries.
Without HTA decisions on treatment are implicitly made.
There are six steps in performing economic evaluations in health care:
1. Study design
2. Costs: measuring and valuation
3. Effects: measuring and valuation
4. Discounting
5. Sensitivity analysis
6. Policy making.
1. STUDY DESIGN
What perspective?
o Healthcare, societal, patient and insurer.
What is the comparator?
o Most effective alternative, no treatment, standard treatment
Placebo is not recommended do not want to give people
something
Types of analysis
o CMA, CBA, CEA, CUA (effects in QALY, costs in monetary terms)
Time horizon
o Lifetime, 10 years? What is the best for this intervention.
o You want this complete as possible.
2. MEASURING AND VALUING COSTS
Identify all relevant costs items
Measure resource use
Value resource use
Health sector, downstream costs, patient/family costs, productivity
losses.
Costs is quantity times price= c=q*p.
You have variable costs and overhead costs = costs of resources that serve many
departments and programs. These costs are not directly linked to patient service.
Direct allocation or step-down allocation.
, You usually use the mean costs. But this may not be stable for each country.
o You need variable and fixed costs (overhead)
o The costs are highly skewed, so the mean is the most informative.
You must search in literature, treatment guidelines, pilot samples and earlier
studies, expert opinion, patient organizations.
prices from the past must be converted to true value via conversion
or indexing.
Opportunity costs: the economic net benefit forgone when
selecting one option rather than the next best alternative.
Productivity costs: costs associated with production loss
and replacement due to illness, disability, and death of a
productive person, paid and unpaid.
o Presenteeism: reduced productivity
o Absenteeism: ill and absent from work
o Permanent disability
o Premature death, before retirement age.
The aim is to quantify the impact of illness on production of
individuals in monetary terms. captured in QALY.
Why would we include productivity costs?
o Inclusion might favor health care programs for working individuals over
others inequity. Elderly people, young people.
Wealth gains could be distributed, less inequity
o Recommendation:
Report productivity costs separately, policymakers might choose
specific weight per cost category.
How to include these productivity costs? VALUATION
o Transfer payment
Set equal to sickness payment from the government.
Societal benefits are not equal to production value.
It is not an indication on wealth increase or decrease. It is
only transfer of money.
Societal benefits are a redistribution of wealth and
not costs.
Not a good option.
o Human capital method
Time absent*wage= productivity costs. The hours not worked are
hours lost.
It is in practice not that high.
Short term absence colleagues taking over, making up
after return to work, cancelling non-urgent activities
Long-term absence lower productivity costs than estimated
by the HCM replacement by unemployed, reallocating jobs,
replacing labor by capital.
o Friction cost method
The employer’s perspective and hours are lost only if those hours
are not worked until another employee takes over the patient’s
work.
The FCM will always be lower than the HCM. When the
unemployment in the society is high FCM will be very much lower.
If the unemployment rate is low, FCM will tend towards HCM.
Measurement of productivity costs:
o Q-method: VAS for productivity at work (10 is optimal, 0 is none)
o Combined: VAS*number of hours work* duration*price per hour
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