cost-effectiveness analysis and sas · cost-effectiveness analysis and sas ... cost benefit...
TRANSCRIPT
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COST-EFFECTIVENESS ANALYSIS
and
SAS
Wanrudee Isaranuwatchai, PhD
SAS Health User Group 11 April 2014
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Disclaimer
© Wanrudee Isaranuwatchai, PhD
These views are my view and not the view of the people or place with whom I work.
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Overall Objectives
© Wanrudee Isaranuwatchai, PhD
Economic evaluation 101
CEA and SAS in action
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Outline
© Wanrudee Isaranuwatchai, PhD
Why do economic evaluation?
What is economic evaluation?
How to estimate cost-effectiveness?
How to estimate cost-effectiveness in SAS?
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Health Care: Medications, Devices, …
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Factors to Consider
© Wanrudee Isaranuwatchai, PhD
Cost
What you will get (e.g., outcome, effect)
Budget
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What is Economics?
Objective and Constraints
Objective Maximize profit, patients treated, quality of care, etc.
Constraints Limited money, time, people, space, machines, etc.
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Scarcity and Tradeoffs
Health (41%) Education and social services (59%)
Source: Ontario Ministry of Finance
2011-2012 Program Expense
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Scarcity and Tradeoffs
Health (41%) Education and social services (59%)
Source: Ontario Ministry of Finance
2011-2012 Program Expense
Health (70%) Education and social services (30%)
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Why Do Economic Evaluation?
© Wanrudee Isaranuwatchai, PhD
Health care resources = scarce
Therefore,
Choices must be made.
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Old School Methods
© Wanrudee Isaranuwatchai, PhD
What we did last time
Gut feelings
Educated guesses
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Outline
© Wanrudee Isaranuwatchai, PhD
Why do economic evaluation?
What is economic evaluation?
How to estimate cost-effectiveness?
How to estimate cost-effectiveness in SAS?
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Economic Evaluation = a Tool
© Wanrudee Isaranuwatchai, PhD
A technique that objectively compares 2 or more treatments
Considers both cost and effect simultaneously
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Different Types of Economic Evaluation
© Wanrudee Isaranuwatchai, PhD
Cost Benefit Analysis (CBA)
Cost Utility Analysis (CUA)
Cost Effectiveness Analysis (CEA)
Cost Minimization Analysis (CMA)
Budget Impact Analysis
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Different Types of Economic Evaluation
© Wanrudee Isaranuwatchai, PhD
Cost Benefit Analysis (CBA)
Cost Utility Analysis (CUA)
Cost Effectiveness Analysis (CEA)
Cost Minimization Analysis (CMA)
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Different Types of Economic Evaluation
© Wanrudee Isaranuwatchai, PhD
Cost Benefit Analysis (CBA)
Cost Utility Analysis (CUA)
Cost Effectiveness Analysis (CEA)
Cost Minimization Analysis (CMA)
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The Importance of Effect (Outcome)
© Wanrudee Isaranuwatchai, PhD
CBA Outcomes in $$$
CUA QALY (quality-adjusted life years), Q and q
CEA Natural unit (e.g., number of falls, pain level)
CMA 0 (no outcome)
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Perspective
© Wanrudee Isaranuwatchai, PhD
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Perspectives in Health Care
© Wanrudee Isaranuwatchai, PhD
Patients
Society
Hospital
Government
Industry
Caregivers
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© Wanrudee Isaranuwatchai, PhD
• Cost • Effect • Perspective
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Statistically, what economic evaluation is about?
© Wanrudee Isaranuwatchai, PhD
NOT about hypothesis testing
Creating a cost-effectiveness estimate
Characterizing the uncertainty of the estimate
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© Wanrudee Isaranuwatchai, PhD
Estimates Incremental Cost-Effectiveness Ratio (ICER)
Incremental Net Benefit (INB)
Uncertainty Cost-Effectiveness Acceptability Curve
Fieller’s Theorem Confidence Interval
Confidence Ellipse
Statistically, what economic evaluation is about?
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Outline
© Wanrudee Isaranuwatchai, PhD
Why do economic evaluation?
What is economic evaluation?
How to estimate cost-effectiveness?
How to estimate cost-effectiveness in SAS?
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Cost-Effectiveness Estimate - ICER
© Wanrudee Isaranuwatchai, PhD
Incremental Cost-Effectiveness Ratio (ICER) One approach
To compare COST and EFFECT between 2 groups
ICER = EXTRA cost for 1 more unit of outcome (effect)
∆C / ∆E
𝐼𝐶𝐸𝑅 =𝐶𝑇𝑋
− 𝐶𝑈𝐶
𝐸𝑇𝑋 − 𝐸𝑈𝐶
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WTP Willingness-to-pay
ICER
+ Value
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General Decision Rules
What you want > your budget SAY NO
What you want < your budget SAY YES or BUY
© Wanrudee Isaranuwatchai, PhD
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General Decision Rules
ICER > WTP Not cost-effective
ICER < WTP Cost-effective to invest
© Wanrudee Isaranuwatchai, PhD
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Compared to UC, is TX cost-effective?
© Wanrudee Isaranuwatchai, PhD
ICER = Extra cost for 1 unit of effect
Cost-effective:
ICER < WTP
ΔC / ΔE
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Outline
© Wanrudee Isaranuwatchai, PhD
Why do economic evaluation?
What is economic evaluation?
How to estimate cost-effectiveness?
How to estimate cost-effectiveness in SAS?
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© Wanrudee Isaranuwatchai, PhD
3 approaches to estimate ICER
means
ttest
regression (simple linear regression)
How to estimate ICER in SAS?
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Data
© Wanrudee Isaranuwatchai, PhD
ID TX COST EFFECT
1 1 $100 90
2 1 $200 80
3 1 $300 70
4 0 $600 40
5 0 $500 30
6 0 $400 45
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proc means
© Wanrudee Isaranuwatchai, PhD
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proc means
© Wanrudee Isaranuwatchai, PhD
𝐼𝐶𝐸𝑅 =𝐶𝑇𝑋
− 𝐶𝑈𝐶
𝐸𝑇𝑋 − 𝐸𝑈𝐶
= 200 – 450 70 – 25
= ΔC = -250 = -5.6 ΔE 45
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proc ttest: cost
© Wanrudee Isaranuwatchai, PhD
= ΔC = -250 = -5.6 ΔE 45
ICER = 200 – 450 70 – 25
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proc ttest
© Wanrudee Isaranuwatchai, PhD
Cost Diff (1-2) = ΔC
Effect Diff (1-2) = ΔE
ICER = ΔC/ΔE
= -250 / 45
= -5.6
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proc reg: cost
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proc reg
© Wanrudee Isaranuwatchai, PhD
MODEL cost = tx; Coefficient of TX dummy = ΔC
MODEL effect = tx; Coefficient of TX dummy = ΔE
ICER = ΔC/ΔE
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Compared to UC, is TX cost-effective?
© Wanrudee Isaranuwatchai, PhD
ICER
Cost-effective:
ICER < WTP
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Summary 1
© Wanrudee Isaranuwatchai, PhD
Why do economic evaluation? Scarcity having to make choices
What is economic evaluation? A tool to help us compare 2 or more treatments
Consider both COST and EFFECT simultaneously
What is cost-effectiveness? Cost; Effect; Willingness-to-pay; Perspective
ICER < WTP
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Summary 2
© Wanrudee Isaranuwatchai, PhD
How to estimate cost-effectiveness? ICER, INB
How to estimate cost-effectiveness in SAS? means, ttest, reg
CEA is about 1. Estimation: ICER, INB
2. Uncertainty: CEAC, Ellipse, CI
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