Epi 213 Decision and Cost-Epi 213 Decision and Cost-Effectiveness Analysis Effectiveness Analysis

(DCEA)(DCEA)

Introduction & OverviewIntroduction & Overview

5 Jan 20125 Jan 2012

TodayToday

Introductions (15 min)Introductions (15 min)

• Course staffCourse staff

• StudentsStudents

Course overview (30 min)Course overview (30 min)

Lecture - Decision Trees (60 min)Lecture - Decision Trees (60 min)

Discussion (15 min)Discussion (15 min)

DCEA StaffDCEA StaffCourse Co-Director:

James G. Kahn, MD, MPHUCSF – IHPS, DEB, GHS

Course Co-Director:Jose Luis Burgos, MD, MPHUCSD – Global Public Health

Section Leaders: James G. Kahn, MD, MPH

  Jose Luis Burgos, MD, MPH

Elliot Marseille, DrPH, MPAHealth Strategies International

Grader:Janelle Downing, MSUCSF – IHPS, Bixby Repro Health

Teaching Assistant:Renee Hsia, MD, MScUCSF – Emerg. Med.

Contact info on course website

James G. Kahn, MD, MPHJames G. Kahn, MD, MPH

HomeHome• UCSF - Institute for Health Policy UCSF - Institute for Health Policy

Studies, Dept of Epidemiology and Studies, Dept of Epidemiology and Biostatistics, Global Health Sciences. Biostatistics, Global Health Sciences.

MissionMission• How can we best spend health care How can we best spend health care

dollars to improve health?dollars to improve health?

• Thus – projects on efficiency in Thus – projects on efficiency in intervention choice & service deliveryintervention choice & service delivery

Cost-effectiveness of Male Circumcision for Cost-effectiveness of Male Circumcision for HIV Prevention in South AfricaHIV Prevention in South Africa

GHIR2 – the dreamGHIR2 – the dream

Jose Luis Burgos, MD, MPHJose Luis Burgos, MD, MPH HomeHome

• UCSD – Division of Global Public Health, Dept. of UCSD – Division of Global Public Health, Dept. of Medicine. Medicine.

• UCSD/ UABC Health Frontiers in Tijuana Project: UCSD/ UABC Health Frontiers in Tijuana Project: First true Binational student run free clinic in the First true Binational student run free clinic in the U.S.-Mexico Border.U.S.-Mexico Border.

MissionMission• How can we improve the role of economic How can we improve the role of economic

evaluation studies in translating EB HIV/TB evaluation studies in translating EB HIV/TB prevention interventions into health policy?prevention interventions into health policy?

• From Cost-Efficacy to Cost-Effectiveness From Cost-Efficacy to Cost-Effectiveness

First Binational Student Run Free Clinic in First Binational Student Run Free Clinic in the U.S. Mexico Border Regionthe U.S. Mexico Border Region

CEA Results

MS Intervention ICER (95% CI) Net savings in HIV averted costs 1,000

FSWs

Offered once only $ 165-$206 $2.1-2.8 million

Offered annually $931-$2,370 $1.3-1.9 million

Mujer Segura Behavioral Mujer Segura Behavioral Intervention is Cost-Effective for Intervention is Cost-Effective for HIV/STI PreventionHIV/STI Prevention

0% 10%

20% 60%

4 0.03

15 5.5

12 3.8

11 3.6

Cost effectiveness ($/QALY gained) HIV related costs not included

* Per 100 person-years

Burgos, et.al. PLoS One 2010

Social determinants of disease

Epidemiology (including disease & risk behavior pattern, and demographics)

Intervention efficacy studies Prevention services research

Resource allocation decision across disease areas

Judgments of the affordability of HIV prevention interventions

Resource allocation decision across HIV prevention activities

Decision Analysis

Cost, cost-effectiveness, and threshold analysis

Multi-attribute utility analysis

Scientific Information

Quantitative Policy

Analysis

Policy & Programmatic

Decision Making

Conceptual framework for evidence based HIV prevention technology transfer activities

Policy Relevant

Holtgrave, 2004

Next Steps: Mixed Methods approach for conducting a policy Next Steps: Mixed Methods approach for conducting a policy relevant cost-effectiveness analysis. relevant cost-effectiveness analysis.

Mexican Policymakers

and Community Based Org. Decision-Makers

Qualitative Interviews

(n=40)Mexican Policymakers and

Community Based Organizations Decision-Makers Quantitative

Questionnaires (n=40)

Mujer Segura Upscale

Implementation Policy Relevant

Cost-Effectiveness

Analysis(12 CBO’s)

Mujer Segura Implementation Project Programmatic Costs and

Health OutcomesN=960

Inform Each Other

Informs Analysis

Informs A

nalysis

Informs Analysis

Renee Y. Hsia, MD, MScRenee Y. Hsia, MD, MSc

HomeHome• UCSF – Department of Emergency UCSF – Department of Emergency

Medicine; San Francisco General Hospital Medicine; San Francisco General Hospital

MissionMission• How do we expand access to emergency How do we expand access to emergency

care, especially for vulnerable care, especially for vulnerable populations?populations?

• Thus – projects on regionalization of Thus – projects on regionalization of emergency careemergency care

DCEA studentsDCEA students

TICR – MCR / ATCR – ~20TICR – MCR / ATCR – ~20

Global Health Masters – ~20Global Health Masters – ~20

Translational Medicine – ~4Translational Medicine – ~4

Other (mainly clinical) - ~7Other (mainly clinical) - ~7

DCEA structureDCEA structure Six cycles of lecture + section:Six cycles of lecture + section:

• Decision treesDecision trees

• Valuing health: QALYs/DALYsValuing health: QALYs/DALYs

• Adding costs: Cost-effectivenessAdding costs: Cost-effectiveness

• Data inputsData inputs

• Sensitivity analysesSensitivity analyses

• Markov disease-state modelingMarkov disease-state modeling

Sections:Sections:• Review HW (10 min)Review HW (10 min)

• Review student projects – 10 min each - structured summary / Review student projects – 10 min each - structured summary / critique / discussioncritique / discussion

Special topics:Special topics:• Excel tutorialExcel tutorial

• HIVHIV

• Behavioral economicsBehavioral economics

• Other TBD – TB, orthoOther TBD – TB, ortho

DCEA student work & gradingDCEA student work & grading Readings – prioritize Lecture Notes over articlesReadings – prioritize Lecture Notes over articles Homework / problem sets (5)Homework / problem sets (5)

• Mainly on mammographyMainly on mammography• First is open-ended, then 3 programmed (excel)First is open-ended, then 3 programmed (excel)• One on CEA article reviewOne on CEA article review• Skip cycle 4Skip cycle 4• Value: 50 points (10 each) – late homework downgradedValue: 50 points (10 each) – late homework downgraded

Own project – DA / CEAOwn project – DA / CEA• Design & implement simple CEA.Design & implement simple CEA.• Start with Excel templates; ok to use other softwareStart with Excel templates; ok to use other software• Each cycle, add new element (and update), feedback from mentorEach cycle, add new element (and update), feedback from mentor• By end, have complete simple DA/CEABy end, have complete simple DA/CEA• Typically solo; can work in pairs if add partial manuscriptTypically solo; can work in pairs if add partial manuscript• Given preliminary score and chance to refineGiven preliminary score and chance to refine• Value: 50 pointsValue: 50 points

Final examFinal exam• Optional, if needed due to problems with HW/projectOptional, if needed due to problems with HW/project

DCEA MentorsDCEA MentorsMentorMentor Area(s) of focusArea(s) of focus

JGKJGK HIV prevention & treatment; variedHIV prevention & treatment; varied

JLBJLB HIV, TB, otherHIV, TB, other

RYHRYH Emergency medicine, surgical capacityEmergency medicine, surgical capacity

JMDJMD Reproductive healthReproductive health

EAMEAM HIV, TB, diabetesHIV, TB, diabetes

Joanne SpetzJoanne Spetz Labor economicsLabor economics

Wendy MaxWendy Max Tobacco, international healthTobacco, international health

Marc PechevisMarc Pechevis HIV, malaria, TB, variedHIV, malaria, TB, varied

Elissa OzanneElissa Ozanne Breast cancer, shared decision-makingBreast cancer, shared decision-making

Antonio WestphalenAntonio Westphalen ImagingImaging

Others as approp.Others as approp. Repro. health, ortho, global health, etc.Repro. health, ortho, global health, etc.