Post on 26-Jan-2017
Health Economics & Evidence Based Practice
Stephen Kinsella KBS
stephen.kinsella@ul.iewww.stephenkinsella.net
2 Sections
3 Ideas
Microcosting
Screening Programmes
Simple Clinical Scores
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Microcosting
How Much?
Background
Background
McElligott, Kinsella, & Roy (2006, 2009)
Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital
Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital
Q: How much did this cost?
Data
Data176 variables
Data176 variables 17 different antimicrobials,
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations2 x National Neonatal Transport Transfer
Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations2 x National Neonatal Transport TransferFamily’s Time, Equipment Maintenance,
Refurbishment, and more
Day 19 Fungal Sepsis, Transfer to Crumlin
Day 202RSV Vaccination
Total Cost
TC = €665,219.88 1 week: cost €5,167.50Fixed cost: €26,608.00
Very precise data implies increased cost
TC, MC substantially larger than UK, US estimates.
So What? Vast Budget Implications
Conclusion
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Simple Clinical Scoring
Kellett et al 2006, 2007, 2008
Simple tests give predictive scores which save time, effort, money, and, maybe, lives.
Big Q: How much?
Cost Effectiveness of Screening for Dementia
Trepel & Kinsella, 2008, Trepel’s PhD
Simple Idea, very complex implementation
Cochrane Review on Costing Studies
What methods do people use when making ec. evaluations
What numbers do they get, and why?
A meta analysis (see poster)
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Ching?
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
5. Private Funding opportunities also exist, please contact me directly for details.
Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
5. Private Funding opportunities also exist, please contact me directly for details.
Questions I want to askHow much?
Comparison/Evaluation of different methods
Tricky data problems
Health Economics & Evidence Based Practice
Stephen Kinsella KBS
stephen.kinsella@ul.iewww.stephenkinsella.net