Cost utility analysis: health economic studies - GOV.UK

The ICER is calculated by taking the ratio between the incremental cost and the incremental QALY , which gives you the cost per additional ... Skiptomaincontent CookiesonGOV.UK Weusesomeessentialcookiestomakethiswebsitework. We’dliketosetadditionalcookiestounderstandhowyouuseGOV.UK,rememberyoursettingsandimprovegovernmentservices. Wealsousecookiessetbyothersitestohelpusdelivercontentfromtheirservices. Acceptadditionalcookies Rejectadditionalcookies Viewcookies Youcanchangeyourcookiesettingsatanytime. Hidethismessage Home Healthandsocialcare Publichealth Healthimprovement Guidance Costutilityanalysis:healtheconomicstudies Howtouseacostutilityanalysistoevaluateyourdigitalhealthproduct. From: UKHealthSecurityAgency Published 13October2020 Getemailsaboutthispage Contents Whattouseitfor Pros Cons Howtocarryoutacostutilityanalysis Example:ThePASStudy Moreinformationandresources Printthispage Thispageispartofaguidetoevaluatingdigitalhealthproducts. Costutilityanalysis(CUA)isonetypeofeconomicevaluationthatcanhelpyoucomparethecostsandeffectsofalternativeinterventions.CUAmeasureshealtheffectsintermsofbothquantity(lifeyears)andqualityoflife.Thesearecombinedintoasinglemeasureofhealth:quality-adjustedlifeyears(QALYs). CUAcanhelpyouunderstandhowfaryourproductextendspeople’slives(lifeyeargains)andimprovesthequalityoflifecomparedtoalternativeoptions.Theincrementalcostandincrementaleffect(QALY)ofyourproductisthencombinedintoasinglemetric,thecostperQALY(orincrementalcost-effectivenessratio). CUAstudiesareroutinelyusedintheUKtoinformresourceallocationdecisionsacrossdifferenthealthcaresettings.Forexample,theyhelpinformdecisionsmadebytheNationalInstituteforHealthandCareExcellence(NICE)aboutwhichdrugsandmedicaldevicestoprovideintheEnglishNHS. Whattouseitfor Useacostutilityanalysiswhen: youwanttoassessthevalueformoneyofadigitalproductthatmightbefundedbytheNHS youneedtoestablishthecost-effectivenessofaproductthatislikelytoinvolveahighfinancialcommitmentfromthepayer bothquantityandqualityoflifeareimportantdimensionsofthehealthbenefitsfromusingyourproduct Pros Advantagesinclude: QALYsshowhealthbenefitsintermsofbothquantityandqualityoflife CUAfacilitatescomparisonsacrossdifferenthealthinterventionsandpoliciesbyusingacommonunitofeffect(QALY) CUAcaninformresourceallocationdecisionsacrossdifferenthealthcaresettings Cons Drawbacksinclude: qualityoflifemeasurestendtobemoresubjectivethanclinicalmeasures generichealth-relatedqualityoflifeinstrumentscanbelessaccurateatcapturingsubtlehealtheffects,forexample,effectsonmentalhealth CUAdoesnotcapturenon-healtheffects Howtocarryoutacostutilityanalysis Youshouldfollowthegeneralconsiderationsforanyeconomicevaluationstudy.Therearealsopointsthatareparticularlyrelevanttocostutilityanalysis(CUA): Choosingyourstudyperspective CUAstudiesaimtoinformresourceallocationtoachievemaximumpopulationhealthforagivenhealthbudget.Inprinciple,theyshouldtakeabroadsocietalperspective.Thiswouldconsiderallcosts,whoeverincursthem,andeffectsbeyondthepatient. However,quantifyingthecostsandeffectstoeveryonedirectlyorindirectlyaffectedbyadigitalhealthproductcanbeverychallenging.Asaresult,CUAusuallyadoptstheperspectiveoftheNHSandpersonalsocialservices.ThisistheviewpointrecommendedbyNICEforitsHealthTechnologyAppraisalProgramme. Measuringeffects QALYsattempttocombinetheeffectsofyourproductonbothmortality(howlongpeoplelivefor)andmorbidity(howwellpeopleare).OneQALYrepresentsoneyearoflifeinfullhealth.TocalculateQALYs,youwillneedtomeasure: lifeyears health-relatedqualityoflife(HRQL) Lifeyearsareestimatesofhowfaraninterventionextendslife. HRQLreflectsanindividual’sperceptionsoftheirownhealth,shownasspecifichealthstatesordimensions. TherearemanywaystomeasureHRQL.Themostwidelyusedaregenericmeasures,suchasthe5-dimensionEuroQol(EQ-5D)andthe36-itemSortFormSurvey(SF-36).Eachmeasuresaskindividualstodescribetheirhealthacrossdifferentdomains. Forexample,theEQ-5Dmeasureincludes5dimensions:mobility,self-care,usualactivities,pain/discomfortandanxiety/depression.Patientsindicatetheirownhealthstatebyansweringhowtheyfeelacrossthedifferenthealthdomains.Eachhealthstateisthenassignedavalue,takenfromthegeneralpublic,togenerateanHRQLscore.Forexample,theEQ-5Dscoreusesascalefrom0(death)to1(perfecthealth). QALYsarecalculatedbymultiplyingthetimespentinaparticularhealthstatebythecorrespondingHRQLscore.Forinstance,ifadigitalproductformanagingheartfailureextendsaperson’slifeby5yearsataqualityoflifeby0.8,comparedtoanalternativeoption,thenitwouldgenerate4(5x0.8)QALYs. Reportingtheresults Tosummarisetherelativecost-effectivenessofyourproductcomparedtoalternativeproducts,youshouldreportanincrementalcosteffectivenessratio(ICER).TheICERiscalculatedbytakingtheratiobetweentheincrementalcostandtheincrementalQALY,whichgivesyouthecostperadditionalQALYgained. Forexample,adigitalproductformanagingheartfailuregenerates4QALYscomparedtoanalternativeoption.Ifthatdigitalproductcosts£4,000morethanthealternative,thentheICERwouldbe£4,000dividedby4,thatis£1,000perQALY. Thismeasureisusefultoinformresourceallocationdecisionsatnationallevel.Itallowsaquickassessmentofwhetheraspecificproductiscost-effectivebyidentifyingwhethertheICERisbelowthemaximumadecision-makeriswillingtopayforaQALY. Forexample,thecostperQALYthresholdbyNICEforEnglandandWalesisbetween£20,000and£30,000.Theexampledigitalproductformanagingheartfailurewouldbejudgedhighlycost-effectivebecauseitsICER(£1,000perQALY)iswellbelowthisthreshold. Example:ThePASStudy Smitandothers(2013),‘Cost-effectivenessandcost-utilityofinternet-basedcomputertailoringforSmokingCessation’. ThePersonalAdviceinStoppingSmoking(PAS)programmeforsmokingcessationcombinedmultiplecomputertailoringandtailoredcounsellingbyapracticenurse.Themultiplecomputertailoringconsistedofcomputer-generatedletterspersonalisedaccordingtopatientcharacteristics. TheCUAcompared3options: thePASintervention multiplecomputertailoringonly usualcare Aswellasthemainclinicaloutcome(smokingabstinence),theCUAconsideredhealth-relatedqualityoflifeat12months,measuredusingtheEuroQolEQ-5D. TheCUAtookasocietalperspectiveandconsideredcoststothehealthcaresystemaswellastothepatient: Interventioncosts Theseincludedresourcesneededforthedeliveryoftheweb-basedmultiplecomputertailoringandthenursecounsellingsessions. Costsofthedigitalcomponentrelatedtohostingandmaintenanceofthewebsite.Theyexcludeddevelopmentandresearch-specificcostsbecausethosehadbeenincurredbeforetherelevantimplementationperiod. Healthcareresources Theseincludedhealthcareresourcesusedin: primarycare(GPandnurseconsultations) secondarycare(hospitaladmissions) communityservices(mentalhealthandalternativesupport) Resourceusedatawerecollectedforboththeinterventionandcontrolgroupsusingthestudy’scasereportforms. Patientcosts Theseincludedcoststopatientsof: travel timelostthroughparticipatingintheinterventions over-the-counterdrugs informalcare Datawerecollectedretrospectivelyusingself-reportedquestionnaires. TheresearchersusedtheupdatedDutchmanualforcostanalysisinhealthcareresearchtovaluehealthcareresources.Unitcostsforinformalcarewerebasedonestimatedunpaidworkrates.Timelostduetotheinterventionwascostedusingaverageearnings. TheCUAfoundthatmultiplecomputertailoringonlywasclearlynotcost-effectivebecauseitcostmorethanusualcareandprovidedfewerQALYs. ThePASprogrammewasrelativelymoreexpensive(incrementalcostswere€806),andprovidedasmalladditionalbenefit(0.02QALYs)comparedtousualcare.ThisresultedinacostperQALYof€40,000. BecausetherecommendedwillingnesstopayforaQALYgainintheDutchsystemis€18,000,theCUAstudyconcludedthatusualcarewasthemostcost-effectiveoption. Moreinformationandresources Kidholmandothers2016,‘Cost-utilityanalysisofacardiacrehabilitationprogram:theTeledialogproject’.TheCUAsuggestedthatthetotalcostoftheapp-basedcardiacrehabilitationprogramme(Teledialog)wasabout€1,700higherthantheusualrehabinahospitalsetting.TheQALYgain(HRQLwasmeasuredusingtheSF-36instrument)associatedwithTeledialogwasverysmall(0.004).TheresultingICERwasabout€484,000,suggestingthatthedigitalrehabprogrammewasunlikelytobecost-effective. Warmerdamandothers(2010),‘Cost-utilityandcost-effectivenessofinternet-basedtreatmentforadultswithdepressivesymptoms’.Thestudycomparedaninternet-basedcognitivebehaviouraltherapy,aninternet-basedproblem-solvingtherapy,andusualcare.ItfoundthatbothcostsandQALYs(HRQLwasmeasuredusingtheEQ-5Dinstrument)weresimilaracrossthecomparisongroups.Bothinternet-basedinterventionsappearedtobecost-effectivecomparedtousualcare,butproblem-solvingtherapywasthemostcosteffectivewithacostperQALYof€11,523. Published13October2020 Getemailsaboutthispage Contents Printthispage Relatedcontent Costeffectivenessanalysis:healtheconomicstudies Focusgroupstudy:qualitativestudies N-of-1study:comparativestudies Chooseevaluationmethods:evaluatingdigitalhealthproducts Carryoutyourevaluation:evaluatingdigitalhealthproducts Collection Evaluatingdigitalhealthproducts Explorethetopic Healthimprovement Research,testingandstandards Isthispageuseful? 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