Health Economic Evaluations in Chronic Disease and Palliative Care - PowerPoint PPT Presentation

1 / 20
About This Presentation
Title:

Health Economic Evaluations in Chronic Disease and Palliative Care

Description:

Health Economic Evaluations in Chronic Disease and Palliative Care ... Developed in late 1980s for evaluation of care in the ... supranuclear atrophy (PSP) ... – PowerPoint PPT presentation

Number of Views:28
Avg rating:3.0/5.0
Slides: 21
Provided by: paulmc86
Category:

less

Transcript and Presenter's Notes

Title: Health Economic Evaluations in Chronic Disease and Palliative Care


1
Health Economic Evaluations in Chronic Disease
and Palliative Care
  • Paul McCrone
  • Kings College London

2
Outline of Session
  • Key components of economic evaluations
  • Reviews of economic evaluations
  • Costs of MS
  • Costs of Parkinsons Disease
  • Costs of Parkinsons Plus Syndromes
  • Use of modelling in economic evaluations

3
Key Components of Economic Evaluations
  • Collection of service use data
  • self-recall
  • administrative systems
  • Estimation of unit costs
  • locally specific / nationally applicable
  • issues of generalisability
  • prices or costs?
  • Analysis of cost data
  • Outcome measurement
  • relevance for clinicians and policy makers
  • appropriateness for economic evaluations
  • Synthesis of costs and outcomes
  • Interpretation and use of findings

4
Client Service Receipt Inventory (CSRI)
  • Developed in late 1980s for evaluation of care in
    the community (learning difficulties) and
    hospital reprovision
  • Used in 200 (?) studies in UK and abroad
  • Specific adaptations for each study
  • Data collected from carers, key-workers, patients
    or notes
  • 20 minutes
  • Retrospective period 1-12 months

5
Review of Palliative Care in Hospital, Hospice
and Home (Finlay et al, 2002)
  • Palliative care in hospital (n8)
  • length of stay generally reduced
  • costs not reported
  • outcomes unaffected
  • Home care (n22)
  • outcomes usually better than for usual care
  • costs (reported in 7 studies) were lower
  • Hospice care hospice with home care (n9)
  • outcomes usually better than usual care
  • costs were reported in 1 study and were similar
    to control

6
Review of Specialist Nursing Care (Douglas et al,
2003)
  • 17 studies identified which reported costs and
    outcomes
  • 4 studies focussed on cancer
  • Limited range of costs included
  • No cost-effectiveness ratios reported
  • 1 study found better outcomes and same costs
  • 2 studies found same outcomes and higher costs
  • 1 study found better outcomes and lower costs

7
Review of Palliative Care Teams (Higginson et al,
2003)
  • 14 health economic studies identified
  • 13 were cost studies
  • 1 cost-utility analysis
  • home intervention for patients with AIDS
  • interventions was considered as cost-effective
  • 3 studies adopted a societal perspective
  • 2 studies attempted to assess the costs to
    patients and families
  • Economic analysis had often been attempted when
    clinical benefit failed to be demonstrated,
    rather than measurement of utility and human
    welfare, linked to health-related outcomes, being
    incorporated in study design

8
Review of Palliative Care for Advanced Dementia
(Sampson et al, 2005)
  • Only 2 relevant controlled studies identified
  • Volicer et al (1994)
  • prospective cohort study of a dementia special
    care unit and usual care
  • costs were lower for special care unit patients
    and discomfort was lower, but mortality rate was
    higher
  • Ahronheim et al (2000)
  • RCT of palliative care intervention
  • no difference in costs or outcomes compared to
    usual care

9
Costs of Multiple Sclerosis
  • Questionnaire sent to random sample of 4000 MS
    Society members
  • Around 2000 responders
  • Four components
  • sociodemographic questions
  • quality of life assessment
  • service use information
  • disability assessment

10
Service Costs by Type of MS
11
Total Costs by Type of MS
12
Variation in Costs
13
Costs of Parkinsons Disease
  • Prospective observational study
  • Patients recruited from primary care and
    specialist clinics (total n174)
  • Service use recorded
  • primary care services
  • secondary care
  • tests/investigations
  • medication
  • informal care

14
Service Costs by Stage of Parkinsons Disease
15
Costs of Parkinsons Plus Syndromes
  • Natural History Neuroprotection in Parkinson
    Plus Syndromes
  • Two diseases
  • multiple system atrophy (MSA)
  • progressive supranuclear atrophy (PSP)
  • 3 countries (France, Germany and UK), 50 sites,
    731 participants
  • Service use measured at 0, 6, 12, 24 36 months
  • Costs calculated using country specific data

16
Service Costs by Time Point
17
Informal Care as Proportion of Service Costs
18
Use of Decision Models
  • Trials and observational studies arguably provide
    the best data, but ....
  • ... they are expensive and results are often not
    known for some time
  • Decision models are an alternative way of
    producing information on the cost-effectiveness
    of interventions
  • Data obtained from a variety of sources
  • Generalisable

19
Decision Model Example
20
Summary
  • Limited but growing number of economic
    evaluations of palliative care
  • High costs associated with disease progression
  • Cost of informal care substantial
  • Decision models are a potential alternative to
    trials
Write a Comment
User Comments (0)
About PowerShow.com