Pharmacoeconomics & Health Outcomes
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Pharmacoeconomics & Health Outcomes
Decision Analysis Part 2
Leon E. Cosler, R.Ph., Ph.D. Associate Professor of Pharmacoeconomics Albany College of Pharmacy
Road Map: Decision Analysis
1.
2.
“Kickin’ it up a notch !”
•
Expected values of non-$$$ outcomes
•
Calculating incremental ratios
Applied examples
•
Monte Carlo simulations
•
Example output
Decision Analysis: Example 2 Consider whether or not to give Ab prophylaxis after c-sect to reduce post-partum infection (endometritis). A normal c-section results in a 3 day stay. If infection occurs, it results in an additional 4 days in the hospital. There are no other significant implications for using the antibiotic (no allergic reactions, etc.)
- What is the expected cost per patient for pts with Ab Tx and without Ab Tx?
Decision Analysis: Example 2 Utilization Data Antibiotic Prophylaxis: Normal C-section Endometritis Probabilities: Endometritis with no Ab: Endometritis with Ab:
Cost $ $ $
Length of Stay 300 7,000 8,000
25% 8%
3 days 4 days
Decision Analysis Prophylaxis
Dx Endo
8%
$ 15,300
$ 1,224
92 %
$ 7,300
$ 6,716
p = 0.08
Normal p = 0.92
$ 7,940
100 %
25 %
$ 15,000
75 %
$ 7,000
$ 3,750
Dx Endo p = 0.25 No Prophylaxis Normal p = 0.75
100%
$ 5,250 $ 9,000
Decision Analysis Prophylaxis
Dx Endo
8%
7
$ 0.56
92 %
3
2.78
p = 0.08
Normal p = 0.92
3.32
25 %
7
75 %
????
1.75
Dx Endo p = 0.25 No Prophylaxis Normal p = 0.75
???? ????
Decision Analysis: Example 2 What is the expected cost per patient and expected LOS for pts with Ab Tx and without Ab Tx?
-
Ab Prophylaxis Results
No Prophylaxis
Expected Costs (per Pt)
Expected Length of Stay (per PT)
Ab Prophylaxis
7940
3.32 days
No Ab
9000
4 days
-
Can I calculate an ICER with this data ?
Decision Analysis Exercise
(Total $$$ A - Total $$$ B) (Total Outcomes A - Total Outcomes B)
(7940-9000)/(3.32-4) = 1558
Decision Analysis: Example 2
- What is the expected cost per healthy patient with Ab Tx and without Ab Tx?
- Ab Prophylaxis
No Prophylaxis
Decision Analysis Prophylaxis
Dx Endo
8%
0
p = 0.08
92 % Normal p = 0.92
100 %
25 % Dx Endo p = 0.25 No Prophylaxis
75 % Normal p = 0.75
1
100%
0.92 patien 0
Decision Analysis •
Do I now have enough data to compute an incremental cost effectiveness ratio? Results
Expected Costs (per Pt)
Healthy Patients
Ab Prophylaxis
$
7,940
0.92
No Ab
$
9,000
0.75
Decision Analysis Exercise
(Total $$$ A - Total $$$ B) (Total Outcomes A - Total Outcomes B) (7950-9000)/(0.92-0.75)= -6235/healthy patient
www.treeage.com
Applied example – Clerkship
Applied example – Clerkship
Applied example – research •
•
Probabilities can be more than just single values They can distributions and you can ‘simulate’ thousands of patients quickly
Applied example – research WTP=$20,000
10000 pegfilgrastim vs. no G-CSF
8000 pegfilgrastim vs. filgrastim
6000 4000 2000 0 -0.8
-0.6
-0.4
-0.2
0
0.2
-2000 no G-CSF vs. filgrastim
-4000
0.4
0.6
That’s all for today… !
Decision Analysis Part 2
Leon E. Cosler, R.Ph., Ph.D. Associate Professor of Pharmacoeconomics Albany College of Pharmacy
Road Map: Decision Analysis
1.
2.
“Kickin’ it up a notch !”
•
Expected values of non-$$$ outcomes
•
Calculating incremental ratios
Applied examples
•
Monte Carlo simulations
•
Example output
Decision Analysis: Example 2 Consider whether or not to give Ab prophylaxis after c-sect to reduce post-partum infection (endometritis). A normal c-section results in a 3 day stay. If infection occurs, it results in an additional 4 days in the hospital. There are no other significant implications for using the antibiotic (no allergic reactions, etc.)
- What is the expected cost per patient for pts with Ab Tx and without Ab Tx?
Decision Analysis: Example 2 Utilization Data Antibiotic Prophylaxis: Normal C-section Endometritis Probabilities: Endometritis with no Ab: Endometritis with Ab:
Cost $ $ $
Length of Stay 300 7,000 8,000
25% 8%
3 days 4 days
Decision Analysis Prophylaxis
Dx Endo
8%
$ 15,300
$ 1,224
92 %
$ 7,300
$ 6,716
p = 0.08
Normal p = 0.92
$ 7,940
100 %
25 %
$ 15,000
75 %
$ 7,000
$ 3,750
Dx Endo p = 0.25 No Prophylaxis Normal p = 0.75
100%
$ 5,250 $ 9,000
Decision Analysis Prophylaxis
Dx Endo
8%
7
$ 0.56
92 %
3
2.78
p = 0.08
Normal p = 0.92
3.32
25 %
7
75 %
????
1.75
Dx Endo p = 0.25 No Prophylaxis Normal p = 0.75
???? ????
Decision Analysis: Example 2 What is the expected cost per patient and expected LOS for pts with Ab Tx and without Ab Tx?
-
Ab Prophylaxis Results
No Prophylaxis
Expected Costs (per Pt)
Expected Length of Stay (per PT)
Ab Prophylaxis
7940
3.32 days
No Ab
9000
4 days
-
Can I calculate an ICER with this data ?
Decision Analysis Exercise
(Total $$$ A - Total $$$ B) (Total Outcomes A - Total Outcomes B)
(7940-9000)/(3.32-4) = 1558
Decision Analysis: Example 2
- What is the expected cost per healthy patient with Ab Tx and without Ab Tx?
- Ab Prophylaxis
No Prophylaxis
Decision Analysis Prophylaxis
Dx Endo
8%
0
p = 0.08
92 % Normal p = 0.92
100 %
25 % Dx Endo p = 0.25 No Prophylaxis
75 % Normal p = 0.75
1
100%
0.92 patien 0
Decision Analysis •
Do I now have enough data to compute an incremental cost effectiveness ratio? Results
Expected Costs (per Pt)
Healthy Patients
Ab Prophylaxis
$
7,940
0.92
No Ab
$
9,000
0.75
Decision Analysis Exercise
(Total $$$ A - Total $$$ B) (Total Outcomes A - Total Outcomes B) (7950-9000)/(0.92-0.75)= -6235/healthy patient
www.treeage.com
Applied example – Clerkship
Applied example – Clerkship
Applied example – research •
•
Probabilities can be more than just single values They can distributions and you can ‘simulate’ thousands of patients quickly
Applied example – research WTP=$20,000
10000 pegfilgrastim vs. no G-CSF
8000 pegfilgrastim vs. filgrastim
6000 4000 2000 0 -0.8
-0.6
-0.4
-0.2
0
0.2
-2000 no G-CSF vs. filgrastim
-4000
0.4
0.6
That’s all for today… !
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