Lesson 1
Resources are scarce and money can only be spent once. Orphan drugs are those drugs targeted
at rare diseases.
Health technology assessment allows us to make informed (transparent and unbiased) decisions
on which new technology we should invest in.
HTA is the systematic evaluation of properties, effects and/or impacts of health technologies and
interventions. It covers both the direct, intended consequences of technologies and interventions
and their indirect, unintended consequences. (WHO definition)
Evaluations compare 2/more alternatives. Can also be a new one vs an old (currently in place) one
There are 6 steps:
1. Design study
2. Measuring and valuing costs
3. Measuring and valuing benefits
4. Discounting
5. Sensitivity Analysis (different possible outcomes)
6. Applying decision rule
1.1
When conducting an evaluation, we must keep in mind a perspective (it determines which costs
and effects to include in the assessment), the 2 dominant ones are:
1. Healthcare perspective: we consider the costs and effects falling on the health care budget
2. Social perspective: we consider all relevant costs and effects that might affect society
*We can have other perspectives such as the patient one or the insurer perspective but in this
course we will mainly focus on the societal perspective
1.2
Choice of comparator, which can be the most efficient alternative, a standard treatment, or no
treatment at all
,1.3
Different types of analyses
Cost Minimization Analysis CMA:
Focus only on costs, feasible if the treatments being compared have the same effects
Cost Benefit Analysis CBA:
Costs and effects are expressed in monetary terms, done by assigning a monetary value to
the outcomes of the intervention (e.g., monetary value to an extra year of life)
Cost Effectiveness Analysis CEA:
Costs in monetary terms, effects in natural units
Cost Utility Analysis CUA:
Costs in monetary terms, effects in QALY (quality adjusted life years)
*Sometimes effectiveness is used to talk about utility analysis
1.4
A time horizon must be set
If all consequences must be considered, a lifetime horizon is needed. RCT are often limited in time,
economic models extrapolate RCT results to a lifetime horizon.
Sensitivity analyses are needed to find out how sensitive the cost-effectiveness outcomes are to
changes in parameters.
The decision rule is often based on the ICER (Incremental Cost Effectiveness Ratio).
Cost A−Cost B
ICER=
(Effects A−Effects B)
Example ICER: 10000, means that intervention A, compared to B, has an increased cost of 10’000€
per QALY/Life-year gained
Decision rule:
Is the ICER below or above the willingness to pay (WTP) for a QALY? known as the V threshold
Is the ICER below or above the current healthcare production? Known as the K threshold
,V thresholds are sometimes known. Ideally K is what is currently being done and will be removed
once the new technology is in place.
, Lesson 2
Measuring and valuing costs
Cost definition: cost = quantity x price
Costs (and consequences) must be important and relevant to our EE. Costs and consequences
must be measured accurately in appropriate physical units before the valuation, a credible
valuation is needed. Finally, costs and consequences must be adjusted for differential timing
(discounting)
There are 3 steps in costing
1. Identify resource items
2. Measure resource use (how often they are used)
3. Estimate the value of resources
1. IDENTIFY RESOURCES
Cost of organizing and operating the programme (health technology) dealing with the adverse
events caused by the programme.
Listing of all fixed, overhead, and variable costs.
The 5 major medical inputs of suppliers for the health production function are: Hospitals,
physicians, medicines, devices, and diagnostic tests
From a Societal perspective we might include costs like travel costs, informal care costs (family
taking care of the ill), productivity losses (time not spent working)
Resources are scarce and money can only be spent once. Orphan drugs are those drugs targeted
at rare diseases.
Health technology assessment allows us to make informed (transparent and unbiased) decisions
on which new technology we should invest in.
HTA is the systematic evaluation of properties, effects and/or impacts of health technologies and
interventions. It covers both the direct, intended consequences of technologies and interventions
and their indirect, unintended consequences. (WHO definition)
Evaluations compare 2/more alternatives. Can also be a new one vs an old (currently in place) one
There are 6 steps:
1. Design study
2. Measuring and valuing costs
3. Measuring and valuing benefits
4. Discounting
5. Sensitivity Analysis (different possible outcomes)
6. Applying decision rule
1.1
When conducting an evaluation, we must keep in mind a perspective (it determines which costs
and effects to include in the assessment), the 2 dominant ones are:
1. Healthcare perspective: we consider the costs and effects falling on the health care budget
2. Social perspective: we consider all relevant costs and effects that might affect society
*We can have other perspectives such as the patient one or the insurer perspective but in this
course we will mainly focus on the societal perspective
1.2
Choice of comparator, which can be the most efficient alternative, a standard treatment, or no
treatment at all
,1.3
Different types of analyses
Cost Minimization Analysis CMA:
Focus only on costs, feasible if the treatments being compared have the same effects
Cost Benefit Analysis CBA:
Costs and effects are expressed in monetary terms, done by assigning a monetary value to
the outcomes of the intervention (e.g., monetary value to an extra year of life)
Cost Effectiveness Analysis CEA:
Costs in monetary terms, effects in natural units
Cost Utility Analysis CUA:
Costs in monetary terms, effects in QALY (quality adjusted life years)
*Sometimes effectiveness is used to talk about utility analysis
1.4
A time horizon must be set
If all consequences must be considered, a lifetime horizon is needed. RCT are often limited in time,
economic models extrapolate RCT results to a lifetime horizon.
Sensitivity analyses are needed to find out how sensitive the cost-effectiveness outcomes are to
changes in parameters.
The decision rule is often based on the ICER (Incremental Cost Effectiveness Ratio).
Cost A−Cost B
ICER=
(Effects A−Effects B)
Example ICER: 10000, means that intervention A, compared to B, has an increased cost of 10’000€
per QALY/Life-year gained
Decision rule:
Is the ICER below or above the willingness to pay (WTP) for a QALY? known as the V threshold
Is the ICER below or above the current healthcare production? Known as the K threshold
,V thresholds are sometimes known. Ideally K is what is currently being done and will be removed
once the new technology is in place.
, Lesson 2
Measuring and valuing costs
Cost definition: cost = quantity x price
Costs (and consequences) must be important and relevant to our EE. Costs and consequences
must be measured accurately in appropriate physical units before the valuation, a credible
valuation is needed. Finally, costs and consequences must be adjusted for differential timing
(discounting)
There are 3 steps in costing
1. Identify resource items
2. Measure resource use (how often they are used)
3. Estimate the value of resources
1. IDENTIFY RESOURCES
Cost of organizing and operating the programme (health technology) dealing with the adverse
events caused by the programme.
Listing of all fixed, overhead, and variable costs.
The 5 major medical inputs of suppliers for the health production function are: Hospitals,
physicians, medicines, devices, and diagnostic tests
From a Societal perspective we might include costs like travel costs, informal care costs (family
taking care of the ill), productivity losses (time not spent working)
