Designing and Conducting Cost-effectiveness Analyses in Medicine and Health Care

Acknowledgments List of Tables, Figures, and Exhibits Tables Figures Exhibits Preface How to Use this Book A Note on Methods 1 Introduction to Cost-Effectiveness What Is Cost-Effectiveness Analysis? Elements of Cost-Effectiveness Analysis Why Conduct Cost-Effectiveness Analysis? Scope and Aims of Cost-Effectiveness Analysis Cost-Effectiveness Analysis and Policy Making Comparisons Across Diseases Do Cost-Effectiveness Analyses Lead to Policy Changes? Principles of Cost-Effectiveness Analysis The Perspective of a Cost-Effectiveness Analysis The Cost-Effectiveness Ratio The Numerator of the Cost-Effectiveness Ratio The Denominator of the Cost-Effectiveness Equation Allocating Costs in the Cost-Effectiveness Ratio Interpreting the Cost-Effectiveness Ratio Comparing Interventions Defining the Comparator Interpreting Incremental Changes in Cost and Effectiveness.Other Types of Analyses Cost-Effectiveness Versus Cost-Utility Analysis Cost-Benefit Analysis Cost-Minimization Analysis Burden of Disease Analysis 2 Developing a Research Project The Ten Steps to a Perfect Research Project Developing a Research Question Designing Your Analysis Step 1: Learn About the Disease Step 2: Chart Out the Course of the Disease Step 3: List the Data Elements That You Will Need 3 Working with Data Overview Review of Rates Prevalence Versus Incidence The Relationship Between Risks and Rates Risk over a Long Period of Time Understanding Error Common Types of Error Managing Error in Cost-Effectiveness Analysis Frequency Distributions and Random Error Calculating Weighted Means Evaluating Study Limitations Review of Medical Study Designs Evaluating the Medical Literature 4 Finding the Data You Need Overview Finding Information in the Medical Literature Using Electronic Datasets Finding the Electronic Data That You Need Which Dataset Should You Use? Using Data Extraction Tools Using Printed Tabulations of Electronic Data Understanding Error in Electronic Data Using Data from Unpublished Research Projects Using Data from Piggybacked Studies Using Expert Opinion Organizing Your Data Summarizing Journal Articles Summarizing Data 5 Working with Probabilities Overview Incidence and Prevalence Incidence Rate of Influenza-Like Illness.Secondary Transmission of Infectious Disease Secondary Transmission of Influenza Duration of Illness Duration of Influenza-Like Illness Efficacy and Measures of Risk Bias in Screening Interventions Efficacy of Strategies to Prevent Influenza-Like Illness Laboratory Test Data Laboratory Testing for Influenza Distribution of Disease Distribution by Age Distribution by Stage Distribution by Gender, Race, and Socioeconomic Status Other Considerations Regarding the Distribution of Diseases Distribution of Influenza-Like Illness Secondary Complications of Illness Secondary Complications of Influenza-Like Illness Medical Care Utilization Rates Obtained from Electronic Data. Hospitalization Data for Influenza-Like Illness Ambulatory Care Data for Influenza-Like Illness Side Effects Side Effects Due to Vaccination or Treatment Health-Related Quality of Life Scores Obtaining Scores from Published Lists Generating HRQL Scores Using Instruments Mortality Data Mortality Among Persons with Influenza-Associated Conditions 6 Working with Costs Overview Opportunity Costs Three Steps to Estimating Costs Micro-Costing and Gross-Costing Measuring Changes in Costs Fixed Costs and Variable Costs Friction Costs and Transfer Payments Using Diagnosis Codes Future Medical Costs Adjusting Costs Adjusting for Inflation Calculating Cost-to-Charge Ratios Estimating the Cost of Ambulatory and Laboratory Services Discounting Future Costs Assessing the Relevancy of Cost Data.Determining Which Costs to Include Hospital and Ambulatory Costs Time Costs Transportation Costs Side Effects Medication Costs Caregiver Costs 7 Constructing a Model Introduction to Decision Analysis Types of Decision Analysis Models Constructing Simple Decision Analysis Models Building the Influenza Model Defining the Initial Branches Defining Variables in the Decision Analysis Model Entering Formulas Into the Decision Analysis Model Defining Terminal Nodes Defining Ambulatory Care Needs Secondary Complications Defining Antibiotic Use and Side Effects Defining Hospitalization Costs Patient Compliance Final Costs 8 Working with Quality of Life Measures Overview Framework Who Should Valuate HRQL? Deriving HRQL Scores Using Preference-Weighted Generic Instruments HRQL Scores Generated from Large Health Surveys Using Disability-Adjusted Life Years Things to Consider Regarding HRQL Scores The Effect of Age on HRQL The Effect of Disease Stage on HRQL The Effect of an Intervention on HRQL Use of HRQL Scores in Diverse Populations Direct Versus Indirect HRQL Scores 9 Calculating Quality-Adjusted Life Years Overview Using the Life Table Method Charting the Lifetime Health Path of Your Cohort Using the Summation Method Using the DALY Method Calculating QALYs in the Sample Analysis Calculating HRQL Scores for Influenza-Like Illness Calculating Years of Life Lost Calculating QALYs in the Vaccination Arm Calculating QALYs in the Treatment Arm Incremental Cost-Effectiveness of Each Intervention Using QALYs in Decision Analysis Models 10 Conducting a Sensitivity Analysis Overview One-Way Sensitivity Analysis Using One-Way Sensitivity Analyses to Validate a Model Answering Secondary Questions Using One-Way Sensitivity Analyses Determining High and Low Values.Two-Way Sensitivity Analysis Analysis of Influence Determining the Plausible Range of Each Variable Generating an Influence Diagram Monte Carlo Simulation How Monte Carlo Simulations Work Defining Distributions Conducting a Monte Carlo Simulation 11 Preparing Your Study for Publication Overview Content and Structure of Cost-Effectiveness Articles Introduction Methods Results Discussion The Technical Appendix Publishing Your Research What Editors Want Choosing the Appropriate Journal 12 Advanced Concepts Overview Working with Measures of Risk Bayes' Theorem Generating Life Tables Calculating QALE Using Published Data Generating QALE Using Electronic Data Using Markov Models Markov States How Markov Models Work Benefits of Markov Modeling Appendix One: Solutions to Exercises Chapter One Chapter Three Chapter Four Chapter Five Chapter Six Chapter Nine Chapter Ten Appendix Two: Journal Summaries Appendix Three: Census Tables Appendix Four: HRQL Scores Derived from the Years of Healthy Life Measure Appendix Five: Life Tables and Quality-Adjusted Life Tables Appendix Six: The EuroQol Instrument References The Author Index.