Pharmacoeconomics

Cost utility analysis (CUA) Part 1

Lecturer: Enas Abu-Qudais
INB Example

Calculate the INB value for drug C with B per SFD If λ value
was 5$

INB= ( 5x (250-200)) – (530-210)

250 – 320 = - 70

INB < 0 therefore C not cost effective compared with B

Cost Utility Analysis (CUA)
 A subset of CEA
 The outcomes are assessed using a special type of clinical outcome
(QALY)

 QALY : Quality-Adjusted-Life-year

 Utility: Patient preferences, total satisfaction received from consuming

a good or service

 The QALY allows each potential program to be measured according to

the extent to which it extends life expectancy while also improving the
quality of each year lived
 QALY incorporates both
- Morbidity
- Mortality

- Advantage of CUA: Different types of health outcomes and

disease with multiple outcomes of interest can be compared
using common unit such as QALY (Unlike CEA)
- Disadvantage: it is difficult to determine an accurate utility
or preference weight value.

 Perfect health 1.0 μ

 Death a value of 0.0 μ
Steps in calculating QALYs

 1) Develop a description of each disease state or

condition of interest
 2) Choose a method for determining utilities

3) Choose subjects who will determine utilities

4) Sum the product of utility scores by t he length of life

for each option to obtain QALYs
Description

 Should depict the usual health effects expected from

the disease state or condition.
 It should include the amount of pain or discomfort
 Any restrictions on activities
 The time it may take for treatment
 Possible change in health perceptions (worry or
concern)
 Any mental changes.
example

 You often feel tired and sluggish. A piece of tubing has

been inserted into your arm or leg which may restrict
your movement.
There is no severe pain but rather chronic discomfort. You
must go to the hospital twice a week for 6 hours power
visit.
You must follow a strict diet (low salt, little meat)
Many people become depressed because of the nuisances
and restrictions and some feel they are being kept alive by
a machine
Methods of determining
utilities
 Rating Scales(RS)

 Standard Gamble(SG)

 Time Tradeoff (TTO)

Rating Scales (RS)

• A thermometer
like illustration in
which 100
represents perfect
health and 0
represents death.

• 100 equals 1.o

utility score

• How long a person

will be in the
disease state will
influence the score