1 Dyslexia and Cost Effectiveness Prof. dr. Jan van Busschbach De Viersprong Erasmus MC.
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Transcript of 1 Dyslexia and Cost Effectiveness Prof. dr. Jan van Busschbach De Viersprong Erasmus MC.
1
Dyslexia and Cost Effectiveness
Prof. dr. Jan van Busschbach
De Viersprong
Erasmus MC
2
Health Economics
Comparing different allocations Should we spent our money on
• Wheel chairs
• Screening for cancer
• Dyslexia treatment
Comparing costs
Comparing outcome
Outcomes must be comparable Make a generic outcome measure
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Outcomes in health economics
Specific outcome are incompatible Allow only for comparisons within the specific field
• Clinical successes: successful operation, total cure
• Clinical failures: “events”
• Number of correct spelled words
Generic outcome are compatible Allow for comparisons between fields
• Life years
• Quality of life
Most generic outcome Quality adjusted life year (QALY)
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Quality Adjusted Life Years (QALY)
Multiply life years with quality index Quality of life index
1.0 = normal health
0.0 = death (extremely bad health)
Example Losing sense of sight
Quality of life index is 0.5
Life = 80 years
0.5 x 80 = 40 QALYs
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QALY
Quality Adjusted Life Years Area under the curve
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
1
0 10 20 30 40 50 60 70 80
Life years
Ad
jus
me
nt
fac
tor
QA
LY
Co-morbidity
With psychotherapy
No psychotherapy
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A new wheelchair for elderly (iBOT) Special post natal care
Which health care program is the most cost-effective?
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A new wheelchair for elderly (iBOT) Increases quality of life = 0.1
10 years benefit
Extra costs: $ 3,000 per life year
QALY = Y x V(Q) = 10 x 0.1 = 1 QALY
Costs are 10 x $3,000 = $30,000
Cost/QALY = 30,000/QALY
Special post natal care Quality of life = 0.8
35 year
Costs are $250,000
QALY = 35 x 0.8 = 28 QALY
Cost/QALY = 8,929/QALY
Which health care program is the most cost-effective?
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4500 Citations in PubMed
1980[pdat] AND (QALY or QALYs)
0
100
200
300
400
500
600
700
1980 1985 1990 1995 2000 2005 2010
Pub
licat
ions
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QALY league table
Intervention $ / QALYGM-CSF in elderly with leukemia 235,958
EPO in dialysis patients 139,623
Lung transplantation 100,957
End stage renal disease management 53,513
Heart transplantation 46,775
Didronel in osteoporosis 32,047
PTA with Stent 17,889
Breast cancer screening 5,147
Viagra 5,097
Treatment of congenital anorectal malformations 2,778
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Dyslexia and QALYs
Request from CvZ Cost effectiveness protocol dyslexia treatment
According to best standards
• Pharmacoeconomics guidelines
5 weeks…. Leona Hakkaart
Costs
Elly Stolk Outcome (Quality of Life)
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Model based on Patty Gerretsen
70 %
30 %
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Parameters
70% effectiveness N = 233, 1 year and 10 year
Gerretsen et al., 2006
Costs Protocol: € 4.445
CAU: € 2.080
• N = 121 pre-treatment
• Intake Regionaal Instituut voor Dyslexie
200.000 children 6% gets diagnostics
1,8% treatment
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Effect on costs in 4 years
70 %
30 %
€ 4.445
€ 4.445
€ 2.080
But what about the effects on outcome?
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Outcome
Disease specific Better reading skills
Better writing skills
Higher education
But what about generic effects? Quality of life
QALYs
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Value health states dyslexia
No dyslexia, Mild, Severe
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Uni-dimensional value
Like the IQ-test measures intelligence Ratio or interval scale
Difference 0.00 and 0.80 must be 8 time higher than 0.10
Three popular methods have these pretensions Visual analog scale
Time trade-off
Standard gamble
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Visual Analogue Scale
VAS Also called “category scaling”
From psychological research
“How is your quality of life?” “X” marks the spot
Rescale to [0..1]
Dead
Normal health
X
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Time Trade-Off
TTO Wheelchair
With a life expectancy: 50 years
How many years would you trade-off for a cure? Max. trade-off is 10 years
QALY(wheel) = QALY(healthy) Y * V(wheel) = Y * V(healthy)
50 V(wheel) = 40 * 1
V(wheel) = .8
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Of the shelf instrument: EQ-5D
Patient sample “Woortblind”
N = 265 Out of 820
Response rate 32.3%
EQ-5D Patients 0.87
(sd 0.16)
Norm 0.88 (sd 0.16)
MOBILITY I have no problems in walking about I have some……. I am confined to bed
SELF-CARE I have no problems with self-care I have some problems….. I am unable…
USUAL ACTIVITIES I have no problems with performing my usual
activities I have some problems… I am unable….
PAIN/DISCOMFORT I have no pain or discomfort I have moderate ….. I have extreme……..
ANXIETY/DEPRESSION I am not anxious or depressed I am moderately…….. I am extremely…..
Not sensitive in Dyslexia
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Paired comparisons
Severe dyslexia ADHA
Severe dyslexia Crohn
Severe dyslexia Mild Asthma
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Quality of life weights
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Costs per QALY
Elementary school € 33.513 Basis school
Grammar school € 16.332 Middelbare school
Secondary education € 11.558 Vervolgonderwijs
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QALY league table
Intervention $ / QALYGM-CSF in elderly with leukemia 235,958
EPO in dialysis patients 139,623
Lung transplantation 100,957
End stage renal disease management 53,513
Heart transplantation 46,775
Didronel in osteoporosis 32,047
PTA with Stent 17,889
Breast cancer screening 5,147
Viagra 5,097
Treatment of congenital anorectal malformations 2,778
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Limitations
Conservative estimates No involved cost of repeaters
Only costs of CUA in first year
No good estimates of additional income
Limited effect estimates No RCT
No formal estimates of uncertainty
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ISPOR 2007
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Conclusion
Cost per QALY is feasible in dyslexia Cost per QALY of treatment is reasonable Cost effectiveness successfully uses as
argument in reimbursement There is a need for better…
Estimates of effects
Estimates quality of life
Models