Case 3: Economic evaluation of health interventions
Today is the big day for Susan, Mike and George. In one panel session they are going to present their
own research. In the session about the evaluation of healthcare innovations from an economic
perspective, they are presenting a new e-health intervention. The purpose of the e-health
intervention is to provide emotional support for chronically ill persons. The idea behind this e-health
intervention is the following. Overall, in the management of chronic ill patients less attention is being
paid to the emotional consequences of having a chronic disease. These emotional consequences can
be considerable, because experienced limitations in daily functioning can easily provoke negative
thoughts. Not surprisingly, many chronically ill patients are faced with co-occurring mood problems,
such as depression and anxiety. The e-health intervention is minimal psychological intervention
(MPI), which includes elements of cognitive behavioral therapy (CBT) and self-management. MPI is
effective in chronically ill and has the advantage of providing patients with lasting skills to cope with
the depressive feelings. The alternative anti-depressants are equally effective. Susan is going to
present the trial-based economic evaluation which looks at the costs and outcomes measured
alongside the trial. Mike is going to present the results of the model-based economic evaluation that
was conducted to extrapolate the long-term costs and outcomes of the intervention.
At breakfast before the conference an ongoing discussion starts about the types and the results of
economic analyses. George is very fond of the MPI. Due to the self-management chronically ill
become more aware and assertive. As a result, chronically ill patients ask for the care they need the
most. Susan’s presentation does not show any results. She agrees that the chronically ill patients are
more aware of their problems, but this leads to a lower valuation of their utilities and more
healthcare consumption and thus MPI is not cost-effectiveness. George is against MPI, for care
providers this new intervention is not promising. Mike argues that the follow-up period is not long
enough and extrapolating the effects in a model-based economic evaluation leads to improved cost-
effectiveness ratios. Furthermore, Susan only looked at the formal care. If she would have included
informal care, the results would be overwhelming. Susan still believes in the future of MPI. They
discuss whether another evaluation of MPI would have showed its economic benefits.
COVID-19 Task for Post-discussion
Please read the following news article and respond to the question:
“The Cost-Effectiveness of Outbreak Responses: Considerations in the COVID-19 Era”
https://www.cgdev.org/blog/cost-effectiveness-outbreak-responses-considerations-covid-19-era
Based on the article, describe the value and findings of cost-effectiveness analyses in the COVID-19.
Cost-effectiveness analyses can inform decisions about the most efficient, comprehensive, and
feasible strategies to combat COVID-19.
Aims
- Rationale of economic evaluation
- Definition and types of economic evaluation
- Results of an economic evaluation
- Methods to conduct economic evaluation
Why do we need to conduct economic evaluation of healthcare innovations?
Background
Rationale of economic evaluation
- Tension between unlimited needs and limited resources
- Efficient allocation of scarce resources
- Economic evaluation provides a framework for identifying and comparing the costs and
benefits of different options
- Inform decisionmakers about efficient healthcare allocation
,Why should we assess the economic value of health technologies?
Tension between
- Limited financial possibilities
o Healthcare budget constraint
- (Unlimited) increase of healthcare needs/costs
o New, expensive treatments/interventions/innovations
Not enough resources to meet all of society’s needs
Choices have to be made
Goal of decisionmakers
- To efficiently allocate scarce healthcare resources
- To maximize health of the population with limited resources
Health Technology Assessment (HTA)
Health Technology Assessment: a multidisciplinary process that summarizes information about the
medical, social, economic, and ethical issues related to the use of health technology in a systematic,
transparent, unbiased, robust manner (European Commission)
- Broader than economic evaluation
Aims of HTA
- To inform decision making
- To improve the quality of care by promoting an appropriate and rational use of health
technologies
- To facilitate planning for the introduction and diffusion of new technologies
Overview of HTA activity in Europe (EuNetHTA, 2017)
Key payer requirements
, Criteria used to assess medicinal products (European Parliament, 2015)
Economic evaluation
Economic evaluation is a branch of HTA, as for instance epidemiological, judicial, ethical, and social
aspects
Economic evaluation looks at the costs and effects of (new) interventions
- Provide a framework for identifying and comparing the costs and benefits of different
options
- Inform decisionmakers about efficient healthcare allocation
Importance of health economic evaluation
- Increased attention to issues of costs and efficiency
- Increased use of economic data in decisions about the reimbursement or pricing of health
technologies
- Formal use of economic data (e.g. drug reimbursement)
Fourth hurdle (cost-effectiveness) to market access
What is an economic evaluation and what are the types of economic
evaluations?
Definition and types of economic evaluation
Economic evaluation: comparative analysis between two or more health technologies in terms of
costs and effects
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