a methodology for measuring the cost- utility of early childhood developmental interventions quality...

A METHODOLOGY FOR MEASURING A METHODOLOGY FOR MEASURING THE COST- UTILITY OF EARLY THE COST- UTILITY OF EARLY

CHILDHOOD DEVELOPMENTAL CHILDHOOD DEVELOPMENTAL

INTERVENTIONSINTERVENTIONS

Quality of improved life Quality of improved life opportunities (QILO) opportunities (QILO)

Why Do We Need Economic Why Do We Need Economic Analysis?Analysis?

Evaluate political policies (economic perspective)Evaluate political policies (economic perspective) Realisation of benefits for participants, their Realisation of benefits for participants, their

families, and the communityfamilies, and the community Attract further investment (private and public)Attract further investment (private and public) To evaluate the efficiency of programs To evaluate the efficiency of programs

(prioritisation of resources)(prioritisation of resources) Effectiveness = $ Savings and Benefits Effectiveness = $ Savings and Benefits

Benefits and Savings Benefits and Savings Benefit/cost analyses of early childhood

developmental interventions

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Current methodsCurrent methods

Cost AnalysisCost Analysis Cost-Effectiveness AnalysisCost-Effectiveness Analysis Cost-Savings AnalysisCost-Savings Analysis Cost-Benefit AnalysisCost-Benefit Analysis

Governmental PerspectiveGovernmental Perspective

Governmental PerspectiveGovernmental Perspective Short and long term benefits or savings to Short and long term benefits or savings to

governmentgovernment

““Might government funds invested early in the lives Might government funds invested early in the lives of children yield compensating decreases in of children yield compensating decreases in

government expenditures”?government expenditures”?

Problems with this approachProblems with this approach

– Unable to measure disparate programsUnable to measure disparate programs– Frames the case for developmental prevention Frames the case for developmental prevention

too narrowlytoo narrowly– Disjuncture between program objectives and Disjuncture between program objectives and

program evaluation criteriaprogram evaluation criteria– Neglects potential benefits with important Neglects potential benefits with important

consequences for society at largeconsequences for society at large Improved public safetyImproved public safety Living an effective an productive lifeLiving an effective an productive life

The societal perspectiveThe societal perspective

Identifying a common metric outcomeIdentifying a common metric outcome A holistic approach to valuing benefits on an A holistic approach to valuing benefits on an

individual level.individual level. Measures benefits across multiple domains, Measures benefits across multiple domains,

at different times, but still on an individual at different times, but still on an individual level.level.

Possibility of valuing alternative life courses.Possibility of valuing alternative life courses.

Adaptation of QALYsAdaptation of QALYs

Help us make better resource allocation Help us make better resource allocation decisionsdecisions

Choices between groups (clientele/patient) Choices between groups (clientele/patient) competing for specific forms of care are competing for specific forms of care are made explicitmade explicit

Prioritisation of resourcesPrioritisation of resources Provides another piece in the complex Provides another piece in the complex

jigsaw puzzle.jigsaw puzzle.

Concept behind QALYsConcept behind QALYs

Common metric for assessing the extent of Common metric for assessing the extent of benefits gained from a variety of benefits gained from a variety of interventionsinterventions

Quantity and quality of life gainsQuantity and quality of life gains

Quantity and quality of lifeQuantity and quality of life

A QALY places a weight on time in different A QALY places a weight on time in different health stateshealth states

Quantity of life is expresses in terms of Quantity of life is expresses in terms of survival or life expectancysurvival or life expectancy

Quality of life embraces not only health Quality of life embraces not only health status but also a range of other health states status but also a range of other health states e.g. physical and mental capacity e.g. physical and mental capacity

Measuring Quality of lifeMeasuring Quality of life

Standard gambleStandard gamble Time trade-offTime trade-off Rating scalesRating scales Mulitattribute utility functionsMulitattribute utility functions

UtilitiesUtilities Utilities produced represent valuations Utilities produced represent valuations

attached to each health state attached to each health state Continuum between 0 &1 Continuum between 0 &1

Instruments that produce utilitiesInstruments that produce utilities

EQ-5DEQ-5D SF-36SF-36 Health Utilities Index Health Utilities Index (HUI1)(HUi2)(HUI3)(HUI1)(HUi2)(HUI3)

EuroQol-5D EuroQol-5D

Instruments that produce utilitiesInstruments that produce utilities

Arriving at QALY Arriving at QALY Benefits (QALYs)=

Number of QALYs saved through preventing or delaying premature death

+ number of QALYs gained through illness avoided or delayed

- number of QALYs lost from side effects

- loss of benefits from substitution for other drugs or treatment regimes

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Amount of time spent in health state is weighted by the utility score given to that state

Arriving at QALY Arriving at QALY

Data relating to Health Related Quality of Life = Impact of intervention on an individual patient (with and without intervention)

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Arriving at QALY Arriving at QALY

Cost utility ratioCost utility ratio

Difference between the costs of two Difference between the costs of two interventions divided by the difference in the interventions divided by the difference in the QALYs they produceQALYs they produce

Cost utility ratio 2Cost utility ratio 2

E.g. Treatments for a disease T1 & T2E.g. Treatments for a disease T1 & T2T1 generates 0.5111 QALYsT1 generates 0.5111 QALYsT2 generates 0.6016 QALYsT2 generates 0.6016 QALYs

T1 QALY – T2 QALY = 0.0905 QALYsT1 QALY – T2 QALY = 0.0905 QALYs 33 days of perfect health (0.0905 x 365)33 days of perfect health (0.0905 x 365) Addition cost of T2 = $220/patientAddition cost of T2 = $220/patient Therefore it costs $2,431 (220/0.0905) to Therefore it costs $2,431 (220/0.0905) to

generate an additional QALY by using T2generate an additional QALY by using T2

Where to?Where to?– Adapting the methodology (QILO)Adapting the methodology (QILO)– Framing and designing the studyFraming and designing the study – Estimating costs (using methodology developed by Manning, 2004)Estimating costs (using methodology developed by Manning, 2004) – Discounting costsDiscounting costs – Identifying relevant outcomesIdentifying relevant outcomes – Describing the element states and their possible course over time for Describing the element states and their possible course over time for

individuals who receive the intervention and for those who receive each individuals who receive the intervention and for those who receive each alternative.alternative.

– Attain weights for various states (survey)Attain weights for various states (survey)– Combining the elements of each state (measures of effectiveness) into a Combining the elements of each state (measures of effectiveness) into a

single number reflecting the value assigned to that state (Multi-attribute single number reflecting the value assigned to that state (Multi-attribute utility)utility)

– Integrating the values assigned to the statesIntegrating the values assigned to the states – Estimating the probabilities of each outcomeEstimating the probabilities of each outcome – computing a numerical average outcome for each of the alternatives being computing a numerical average outcome for each of the alternatives being

compared.compared.