University of Alberta

Course Guide for SPH 671 Winter 2015 (Campus)

ECONOMIC EVALUATION OF HEALTH CARE MONDAY 1:00 – 3:50 PM

Room L1 - 220

Main Instructors:

Invited Instructors:

Thanh Nguyen Telephone: (780)448-4881 ext. 257 e-mail: [email protected] Office: Institute of Health Economics 1200 10405 Jasper Ave, Edmonton, AB, T5J 3N4

Arto Ohinmaa [email protected] Anderson Chuck [email protected] Charles Yan [email protected] Maria Ospina [email protected]

Course Description

This course aims to teach students about different economic assessment methodologies that are used to evaluate health care services and programs and learn the criteria to select the best set of economic tools for a study question. The evaluation techniques to be covered in the course are cost analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. The course also teaches students about economic analytic modeling techniques and how to use them for economic evaluations of health services.

Objectives

Upon completion of this course, students will be able to: (1) Understand the basic elements used in economic evaluation techniques and apply them in research setting. (2) Identify, measure and value costs and consequences and apply that knowledge to design a research proposal. (3) Calculate different efficiency (cost-effectiveness, cost-utility) ratios and perform cost-benefit analysis. (4) Critically review economic literature and examine how reliable the study results are for decision making. (5) Outline the limitations of each technique. (6) Understand and apply decision tree analysis and Markov model to economic evaluations. (7) Choose and apply the best economic evaluation method for a given decision or policy making problem.

Competencies

1) Be able to apply economic evaluation methods to different research settings in health and social care and apply the best method to the particular problem (cost-effectiveness, cost-utility or cost-benefit analysis). 2) Be able to identify, measure and value costs and consequences and apply that knowledge to design a research proposal. 3) Be able to critically review economic literature and examine how reliable the study results are for decision making and health policy decisions. 4) Be able to explain the possible equity and other population health consequences of resource allocation based on economic evaluations. 5) Be able to apply a simple economic model (e.g. decision tree and/or Markov model) to an economic evaluation using Excel and TreeAge Pro programs. 6) Be able to plan an economic evaluation study for a clinical trial or public health study.

Learning Resources

All required materials are made available through E-class. Lecture notes and reading materials will be provided (hard copies in class and electronic copies in E-class). Required Textbooks:

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 2



Drummond, M, Sculpher M, Torrance, GW, O’Brien,B, Stoddart, GL. Methods for the economic evaluation of health care programs. Third edition. Oxford, Oxford University Press, 2005. Required reading (Available in the U of A bookstore)



Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation. Oxford University Press 2006.

Recommended Textbooks:  Canadian Agency for Drugs and Technologies [CADTH].

Library

Guidelines for economic evaluation of health technologies: Canada. 3rd Edition, Ottawa: CADTH, 2006. Required additional reading (access in the Internet: http://cadth.ca/media/pdf/186_EconomicGuidelines_e.pdf )

The University of Alberta library system’s website www.library.ualberta.ca details the range of services offered to students on and off campus. If you need further information or assistance, contact the Library's Electronic Reference Desk at www.library.ualberta.ca/ereference/index.cfm or call 1-800-2070172.

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 3

Course Evaluation Mid Point Evaluation: As is the case with all SPH instructors, I am interested in improving the course. I need to hear from you in order to do that well. I will gather feedback and recommendations from you at the mid-point of the course, by asking a student to administer and deliver an anonymous course evaluation back to the instructor(s). Final Course Evaluation: Following completion of the course, you will receive a standardized summative evaluation. Course evaluations will be done online by Test Scoring and Questionnaire Services. An invitation to participate in the survey is emailed to each student. One email will be sent for each start date, i.e., if a student has surveys with different start dates, they will receive multiple messages. Note that the message includes a login button.

Student Evaluation Assignment/Exams Paper 1

Percentage 15

Date February 23

Paper 2

25

March 30

Presentation

10

March 23 and March 30

Final test

40

April 13

Class participation

10

Evaluation of Course Work Paper topics: the first assignment is to critically review five costeffectiveness, cost-utility or cost-benefit articles published in peer reviewed journals. Students may concentrate to a certain topic area like heart disease, diabetes, hip and knee surgeries, public health, etc., where economic evaluation studies are used to evaluate different treatment alternatives. The paper will utilize Drummond et al. (2005) quality of economic evaluation criteria (see Chapter 3 in the textbook). The second paper will be to replicate a published Markov or decision tree model evaluating cost- effectiveness of a selected health intervention/service/program/technology using TreeAge Pro software. Students may use one of the articles that you used in the first paper. The short paper and computer program needs to adapt the model in the Alberta/Canada context and utilize local values when available. The paper will include the explanation of the inputs, key outputs from the program and summary of the results. Further details will be provided in the e-class. SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 4

Presentation: Students will present model structure, variables, analyses, and results of the second paper. Final test… Class participation is evaluated based on the participation to the lectures and discussions during lectures, and the process of doing the modelling part during lectures. Grades will be assigned on an absolute basis.

See ‘Assignments and Marking Criteria’.

Grading

University of Alberta Calendar Section 23.4 Regulations and Information for Students Evaluation Procedures and Grading System The University of Alberta Grading System The University of Alberta uses a letter grading system with a four-point scale of numerical equivalents for calculating grade point averages. Grades reflect judgments of student achievement made by instructors. These judgments are based on a combination of absolute achievement and relative performance in a class. Some instructors assign grades as intervals during the course and others assign marks (e.g. percentages) throughout the term and then assign a letter grade at the end. Instructors must adapt their approaches to reflect the letter grading system. Grade distribution should reflect those shown in this document. (EXEC 03 FEB 2003) Descriptor Excellent

Good Satisfactory Failure

Academic Integrity

Grading in Graduate Courses Letter Grade Grade A+ A AB+ B BC+ C CD+ D F

Point Value 4.0 4.0 3.7 3.3 3.0 2.7 2.3 2.0 1.7 1.3 1.0 0.0

Plagiarism is a serious offence. The University of Alberta is committed to the highest standards of academic integrity and honesty. Students are

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 5

expected to be familiar with these standards regarding academic honesty and to uphold the policies of the University in this respect. Students are particularly urged to familiarize themselves with the provisions of the Code of Student Behaviour (online at www.ualberta.ca/CodeofStudentBehaviour) and avoid any behaviour which could potentially result in suspicions of cheating, plagiarism, misrepresentation of facts and/or participation in an offence. Academic dishonesty is a serious offence and can result in suspension or expulsion from the University. University of Alberta policy about course outline can be found in Section 23.4(2) of the University Calendar. (GFC 29 SEP 2003)

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 6

Schedule at a Glance Lecture Date 1 Jan. 5

Topic Introduction to Economic Evaluation

Instructor AO

2

Jan. 12

Cost analysis

TN

3

Jan. 19

-

CEA (2 hours) Modelling 1: Decision tree analysis 1 (50’)

TN

4

Jan. 26

-

CUA (2 hours) Modelling 2: Markov model 1 (50’)

AO TN

5

Feb. 2

-

CBA Critical review of health economic evaluation

AO

6

Feb. 9

Economic evaluation in Public Health and in Health Technology Assessment

Feb. 16

Family Day-Reading week: No class

Feb. 23

Data sources: - Literature review and meta-analysis (2 hours) - Introduction to AH databases (50’)

MO TN

7

AC

8

Mar. 2

Modelling 3: Decision tree analysis 2

TN

9

Mar. 9

Modelling 4: Markov model 2

TN

10

Mar. 16

A real life example of CEA modelling study, including budget impact analysis: presentation and discussion

CY

-

TN

11

Mar. 23

12 13

Students finalize a replicated model for the second paper Students’ presentations

Mar. 30

Students’ presentations

Apr. 6

Easter Monday: No class

Apr. 13

Final exam

Assignment

TN, AO TN

Required and recommended readings Lecture 1:   

Drummond et al., Chapters 1 and 2. Raftery, J. Economic evaluation: an introduction. BMJ 1998;316:1013-1014. Jonsson B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. European Journal of Health Economics 2009; 10:357-359.

Lecture 2:  

Drummond et al., Chapter 4. Jacobs P, Ohinmaa A, Brady B. Providing systematic guidance in pharmaco-economic guidelines for analyzing costs. PharmacoEconomics 23(2):143-53 (February 2005).

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 7

     

Meltzer D. Accounting for future costs in medical cost – effectiveness analysis. Journal of Health Economics 1997;16:33-64. (mainly for source of references) Torgerson, DJ, Raftery, J. Discounting. BMJ 1999; 319:914-915. Polsky D, Glick H. Costing and Cost Analysis in Randomized Controlled Trials; Caveat emptor. Pharmacoeconomics 2009; 27:3:179-188. Palmer, S, Raftery, J. Opportunity cost. BMJ 1999;318:1551-2 Jackson Terri. Using computerized patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies. Health Policy 2001;56:149-163. Thorn J, Coast J, et al. Resource-use Measurement based on patient recall: Issues and challenges for economic evaluation. Applied Health Economics and Health Policy 2013; 11:155-161. See

http://search.proquest.com.login.ezproxy.library.ualberta.ca/docview/1466571095/142C A40FB281130A21A/1?accountid=14474 Lecture 3:  Drummond et al. (2005) Chapters 5  Briggs, A, Gray, A. Using cost effectiveness information. BMJ 2000;320:246.  Palmer, S, Torgerson, DJ. Definitions of efficiency. BMJ 1999;318:1136.  Torgerson, D, Raftery, J. Measuring outcomes in economic evaluations. BMJ 318:1413  Van Hout BA. Discounting costs and effects. Health Economics 1998;7(7):581-594. Lecture 4:  Kind P. Measuring quality of life in evaluating clinical interventions: an overview. Annals of Medicine 2001; 33:323-327.  Drummond M. Introducing economic and quality of life measurement into clinical studies. Annals of Medicine 2001; 33:344-349  Kind P, et al. The use of QALYs in clinical and patient decision-making: issues and prospects. Value in Health 2009; 12 (Suppl. 1): S27-30.  Drummond M, et al. Toward a consensus on the QALY. Value in Health 2009; 12 (Suppl. 1): S31-35.  Lipscomb J, et al. Retaining, and enhancing, the QALY. Value in Health 2009; 12 (Suppl. 1): S18-26. (Optional based on interest of the student) Lecture 5:  Drummond et al., Chapter 3, 5, 7  Hanley N et al. Estimating the monetary value of health care. Health Economics 3-16 (2003).  DAHTA Guidelines (CBA topics)  Bryan S, Dolan P. Discrete choice experiments in health economics. For better or for      

worse? European Journal of Health Economics 2004; 5:4:199-202. Jan Abel Olsen, Richard D. Smith. Theory versus practice: a review of willingness-topay in health and health care. Health Economics 2001; 10:1:39-52. Ryan M, Farrar s. Using conjoint analysis to elicit preferences for health care. British Medical Journal 2000; 320: 1530-3. Hirth, RA, Chernew, ME, Miller, E et al. Willingness to pay for a quality adjusted life year: in search of a standard. Medical Decision Making 2000;20:332-342. CADTH Economic guidelines. Chapter 1 and Chapter 3.1 to 3.5 (pages 12-19) Drummond MF. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996;313:275-283. Husereau D, Drummond M, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. European Journal of Health Economics 2013; 14:367-372. See: http://link.springer.com.login.ezproxy.library.ualberta.ca/article/10.1007/s10198-013-0471-6

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 8

  

Jefferson et al. Quality of systematic reviews of economic evaluation in health care. JAMA 2002: 287:2: 2809-2814. See: http://jama.jamanetwork.com.login.ezproxy.library.ualberta.ca/article.aspx?articleid=194987 Centre for Evidence Based Medicine. Levels of evidence and grades of recommendation for evidence based medicine. Accessed from: www.cebm.net (additional information, self study material, optional) See also http://www.nlm.nih.gov/nichsr/edu/healthecon/index.html for more information about the information sources in health economics and economic evaluation and critical appraisal (additional information, self study material, optional)

Lecture 6:  Economic evaluations in Alberta Health Technology Assessment process  CADTH and economic evaluations  NICE (economic evaluations in the UK decision making); see: http://www.nice.org.uk/  Readings:  Shiell A. In search of social value. International Journal of Public Health 2007; 52:333-334.  Schwappach D. The economic evaluation of prevention – Let’s talk about the case of discounting. International Journal of Public Health 2007; 52:335-336.  Wasem J. Evaluation of prevention: a challenge for economist. International Journal of Public Health 2007; 52:337-338. Lecture 7:  PRISMA. Transparent reporting of systematic reviews and meta analyses. Available at http://www.prisma-statement.org/statement.htm  Badgett RG, O'Keefe M, Henderson MC. Using Systematic Reviews in Clinical Education. Annals of Internal Medicine. 1997;126(11):886-9  Bero LA, Jadad AR. How Consumers and Policymakers Can Use Systematic Reviews for Decision Making. Annals of Internal Medicine. 1997;127(1):37-42  Cook DJ, Greengold NL, Ellrodt AG, Weingarten SR. The Relation between Systematic Reviews and Practice Guidelines. Annals of Internal Medicine. 1997;127(3):210-16  Cook DJ, Mulrow CD, Haynes RB. Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions. Annals of Internal Medicine. 1997;126(5):376- 80  Egger M, Smith GD. Meta-analysis: Potentials and promise. BMJ. 1997;315:1371-74  Egger M, Smith GD, Philips AN. Meta-analysis: Principles and procedures. BMJ. 1997;315:153337  Egger M, Smith GD. Meta-analysis: Bias in location and selection of studies. BMJ. 1998;316:61-6  Gotzsche P, Hrobjartsson A, Marie K, Tendal B. Data Extraction Errors in Meta-analyses That Use Standardized Mean Differences. JAMA. 2007;298(4):430-437  Hunt DL, McKibbon KA. Locating and Appraising Systematic Reviews. Annals of Internal Medicine. 1997;126(7):532-38  Lau J, Ioannidis PA, Schmid CH. Quantitative Synthesis in Systematic Reviews. Annals of Internal Medicine. 1997;127(9):820-26  McQuay HJ, Moore RA. Using Numerical Results from Systematic Reviews in Clinical Practice. Annals of Internal Medicine. 1997;126(9):712-20

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 9

   

Mulrow CD, Cook DJ, Davidoff F. Systematic Reviews: Critical Links in the Great Chain of Evidence. Annals of Internal Medicine. 1997;126(5):389-91 Mulrow C, Langhorne P, Grimshaw J. Integrating Heterogeneous Pieces of Evidence in Systematic Reviews. Annals of Internal Medicine. 1997;127(11):989-995 Shojania KG, Sampson M, Ansari MT, Ji J, Doucette S, Moher D. How Quickly Do Systematic Reviews Go Out of Date? A Survival Analysis. Ann Intern Med. 2007;147:224-233 Higgins, JPT, Green, S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008].

Requirements for Modelling:

-

Reading: o Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation. Oxford University Press 2006. o Drummond et al. (2005) Chapters 9 and 10

-

Laptop with Excel and TreeAge Pro 2014 (www.treeage.com) installed.

SPH 671 [2015] Course Syllabus

University of Alberta, School of Public Health Page 10

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