Conduct a CEA or a CUA where two or more programmes are compared to one another health programmes are compared to one another.
This could include
– increasing the provision of a health intervention for a particular disease.
– introducing a new health intervention for a particular disease.
– switching to a different health intervention for a particular disease.
Describe in detail how you would conduct a CEA or a CUA of your proposed scheme. You are free to focus on an example that you find particularly relevant. The project should be focused specifically on the example that you choose rather than being a general discussion of economic evaluations.
You can present you work in the following ways:
•Under the headings in the 10 point checklist. This will make sure that you have considered all the appropriate elements which make up a good evaluation.
•Under the 4 headings of an academic paper: Introduction, Methods, Results and Discussion.
This will make the project look more professional but make sure you still address the 10 points within the headings.
When trying to establish the effectiveness of the treatments remember that:
- RCTs are the gold standard for determining the effectiveness of one treatment over another.
- Meta-analyses can be used if the time horizon of RCTs is not long enough.
- In the absence of both of these types of data, use observational data but remember that this is the worst type of data to use.
The following, are good places to look for information on costs in health interventions:
- For identifying costs, look for studies which track patient health problems from their disease to their death. This will help you identify all the relevant costs associated with that specific health condition.
- Clinical trials provide good information on the total quantity of resources used for any particular health intervention.
- When trying to value costs, check formularies, hospitals or academic papers for information on the prices of drugs or services. The NHS in the UK publishes data on reference costs each year.
The following, are good places to look for information on the benefits associated with health interventions.
- Clinical trials provide good information on items such as survival and cases detected.
- Also, make sure you try and find any potential side effects of the health interventions. These can also be found in the clinical trials.
- You can also try and measure the benefits in utilities taken from other papers or from one of the indices
Addressing each of the 10 points:
1.Was a well-defined question posed in an answerable form?
Make sure you clearly state the purpose of your paper. What is the outcome, detail alternatives and specify the viewpoint.
2.Was a comprehensive description of all the competing alternatives given?
What are the alternatives? Are any relevant alternatives, costs or consequences omitted?
Do results differ by subgroup or treatment intensity?
3.Was the effectiveness of the programmes or services established?
Clinical trial, meta-analysis, observational data?
4.Were all the important and relevant costs and consequences for each alternative identified?
Categories of costs: Health sector, other sectors, patient/ family resources, productivity.
Depends on the viewpoint. Capital and operating costs.
Consequences: Health state changes, other value created (e.g. reassurance), resources saved.
5.Were costs and consequences measured accurately in appropriate units?
Units for consequences should be easily determined. Costs – quantity of resources used.
Any shared resources? Assumptions? Omissions?
6.Were costs and consequences valued credibly?
Where did you get your outcome measures from? Did you use utilities? Did you use preference measures?
Costs: market values? Per diems? Procedure costs? Sourced from where?
7. Were costs and consequences adjusted for differential timing?
Discounting required? Explain choice of rate?
8.Was an incremental analysis of costs and consequences of alternatives performed?
Additional costs compared to additional effects/benefits/utilities. How much extra do we pay for the additional benefit?
9.Was allowance made for the uncertainty in the estimates of costs and consequences?
Any data issues? Any methodological assumptions? Did you extrapolate? Where did you get your assumption from? Your costs and consequences, are the sourced from somewhere similar?
Sensitivity analysis – what if your key inputs changed (e.g. costs increased?). Ensure the reader knows that the results are sensitive to particular inputs.
10.Did the presentation and discussion of study results include all issues of concern to users?
Who else has looked at this, or something similar? What did they find? How does your study differ?