Cost-Effectiveness Analysis and the Consistency of Decision Making

George, Bethan; Harris, Anthony; Mitchell, Anne

doi:10.2165/00019053-200119110-00004

Cited by 353 publications

(110 citation statements)

References 14 publications

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“…All three strategies had an ICER under $50,000 per LYG, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system [24,31]. An incremental cost of AU$12,405 per LYG, meant colonoscopy screening every five-year appears to be the most cost effective strategy of the three tested.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of family history-based colorectal cancer screening in Australia

et al. 2014

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BackgroundWith 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC.MethodsWe developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case).ResultsUnder the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy.ConclusionThe model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.

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Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of family history-based colorectal cancer screening in Australia

et al. 2014

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“…In contrast, the CEA thresholds advocated by Laupacis et al [3], suggest that health-care programmes, which cost less than US$12 800 (CAN$20 000) per QALY are highly cost effective, but weak if the ratio exceeds US$64 000 (CAN$100 000). A study by George et al [4] suggests that these thresholds are more in line with what is deemed appropriate by decision makers. George et al looked at the past decisions of the Australian Pharmaceutical Benefits Advisory Committee and found that the committee was unlikely to recommend a drug for listing if the additional cost per life year gained exceeded US$40 400 (AU$76 000).…”

Section: Introductionmentioning

confidence: 94%

Willingness to pay for a QALY

Gyrd‐Hansen

2003

Health Economics

123

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A willingness to pay (WTP) per quality-adjusted-life year (QALY) of DKK 88,000 was estimated on the basis of elicited preferences for health states. The WTP per QALY estimate presented here differs considerably from that implied in contingent valuation studies, suggesting that WTP for reducing risk of death is based on other preference structures than is ex post WTP for improvements in quality of life. Results further suggest that different preference structures may exist when respondents are faced with WTP questions in which case elimination of minor health problems are associated with negligible utility.

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“…Willingness to pay (WTP) thresholds for funding of new interventions are primarily published in terms of cost per QALY (with limited WTP thresholds based on life years gained) and so use of cost-utility analysis would enable researchers to compare their study findings against generally accepted WTP thresholds (Kaplan & Bush 1982, George et al . 2001, Simoens 2009, Shiroiwa et al . 2010).…”

Section: Discussionmentioning

confidence: 99%

Is there an economic case for investing in nursing care – what does the literature tell us?

Twigg

Myers

Duffield

et al. 2014

Journal of Advanced Nursing

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AimTo determine the cost effectiveness of increasing nurse staffing or changing the nursing skill mix in adult medical and/or surgical patients?BackgroundResearch has demonstrated that nurse staffing levels and skill mix are associated with patient outcomes in acute care settings. If increased nurse staffing levels or richer skill mix can be shown to be cost-effective hospitals may be more likely to consider these aspects when making staffing decisions.DesignA systematic review of the literature on economic evaluations of nurse staffing and patient outcomes was conducted to see whether there is consensus that increasing nursing hours/skill mix is a cost-effective way of improving patient outcomes. We used the Cochrane Collaboration systematic review method incorporating economic evidence.Data sourcesThe MEDLINE, CINAHL, SPORTDiscus and PsychINFO databases were searched in 2013 for published and unpublished studies in English with no date limits.Review methodsThe review focused on full economic evaluations where costs of increasing nursing hours or changing the skill mix were included and where consequences included nursing sensitive outcomes.ResultsFour-cost benefit and five-cost effectiveness analyses were identified. There were no cost-minimization or cost-utility studies identified in the review. A variety of methods to conceptualize and measure costs and consequences were used across the studies making it difficult to compare results.ConclusionThis review was unable to determine conclusively whether or not changes in nurse staffing levels and/or skill mix is a cost-effective intervention for improving patient outcomes due to the small number of studies, the mixed results and the inability to compare results across studies.

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Cost-Effectiveness Analysis and the Consistency of Decision Making

Abstract: The results of this preliminary study indicate that decisions to recommend a drug for listing by the PBAC in the last few years have, by and large, been consistent with the notion of economic efficiency.

Cited by 353 publications

References 14 publications

Cost-effectiveness of family history-based colorectal cancer screening in Australia

Cost-effectiveness of family history-based colorectal cancer screening in Australia

Willingness to pay for a QALY

Is there an economic case for investing in nursing care – what does the literature tell us?

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