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Cost - Effectiveness Analysis (CEA)
Cost - Effectiveness Analysis (CEA)
Cost - Effectiveness Analysis (CEA)
MEASURE OF EFFECTIVENESS :
−Depent on the objectives of the particular interventions under review.
−Measures of effectiveness should be defined in appropriate natural units and, ideally, expressed
in a single dimension.
−Example of effectiveness measuremen are ;
o Lives saved
o Life years gained
o Cases treated appropriately
o Pain or symptoms free days
o Cases succesfully diagnosed
o Complication avoided
OBTAINING EFFECTIVENESS DATA
−Ideally, data on effectiveness may obtained alongside clininc trials so that relevant data on costs and
effectiveness can be collected at the same time.
−Howeevr, setting up and conducting appropriated trials is often time consuming and expensive. Becouse
of this, many CEA rely on the exiting medical literature for their data.
−Even when data are available it is important to ensure that they are relevant to the context in which an
evaluation is being carried out.
−Example, do medical and other staff have the same skills and experience as those reported in the
studies?. Is the same range of medical and surgical equipment available?.
−Economic evalution may have to rely on assumptions about clinical evidence thus the result are subjected
to a range of different assumptions about effectiveness. This can be done by sensitivity analysis.
b) Extreme Scenarios :
− Identify extreme estimates of cost and effectiveness and effectiveness so that two
procedures can be compared under pessimistic (high cost and low effectiveness) and
optimistic (low cost and high effectiveness) assumptions.
− Another way to identify objectives is to perform exploratory study which compare the
performance of two ot more approaches currently being used to meet some objective,
or examining the expected performance of completely new approaches to an objective.
3. IDENTIFYING AND MEASURING THE COSTS OF EACH OPTION
− The resources that are costed should be those that are responsible for producing the
effects that will be measured.
− Another thing to stress about costs is the need to be comprehensive, that is to include
all the input that are put to work in that option.
− Donation. Volunteers as well as paid – for resources should be included.
− Take care not to count any resources more than once (double – counting).
− Where a new service or set of servicer is being added to an existing program, it will be
sufficient to look only at the costs and effects of the new components (additional /
incremental / marginal costs).
− However, by doing this, there is risk of overlooking other differences, and obscuring
the exact meaning of the cost effectiveness indicator.
4. IDENTIFYING AND MEASURING THE EFEECTIVENESS OF EACH OPTION
− It is important to be sure that the effects that measured are result from the resource
inputs whose costs are calculated.
− Important methodological issue to be addressed in the choise of effectiveness measure
is whether to choose final health outcome such as life – years gained, or an
intermediate outcome such as cases found or patients appropriate treated.
− In general though, one should choose an effectineness measure relating to a final
outcome.
− Intermediate outcome are admissible, although care must be taken to establish a link
between these and a final health outcome, or show that the intermediate outcomes
themselves have some value.
− Especially on prevention outcome becouse studies to estimate an improvement in final
endpoints are costly and time – consuming to conduct.
− Major sources of effectiveness dat is the existing medical literature.
− In situations where no good clinical evidence exists, and the CEA may procees by
making assumptions about the clinical evidence and then undertaking a sensitivity
analysis of the economic result to different assumptions.
4. CALCULATING THE COST – EFFECTIVENESS OF EACH OPTION AND INTERPRETING
THE RESULT
− Cost – effectiveness ration for each option can be calculated by dividing its cost by the
numerical value of the chosen effect.
− The ratios are then compared to determine the most cost – effective option, that is the
one costing the least per unit of effect achieved.
− To deal with this kind of uncertainty for a perticular assumption, define a plausible
range of values for the variable, or take (1) the best estimate, (2) twice that estimate
and (3) half of it.
− Taking each of these figures in turn (or using the values at either end of the plausible
range), calculate how the results of CEA change with the different values.
− If the conclusion as to the most cost – effective option changes, then the conclusion
are said to be sensitive to the assumption about the value of that variable (sensitivity
analysis).
− Having established which of the options is the most cost – effective, an important
follow – up step is to decide what is responsible for the diffrerences among them.