Methods for the Economic Evaluation of Health Care Programmes by Greg L. Stoddart

Author:Greg L. Stoddart [Stoddart, Greg L.]
Language: eng
Format: epub
Publisher: Oxford University Press - A
Published: 2005-07-21T07:00:00+00:00

6. Were costs and consequences valued credibly?

X YES _NO __CAN’T TELL

Costs were valued in 1999 Canadian dollars. Unit costs that were not available for the year 1999 were appropriately adjusted to 1999 using the health and personal care component of the Consumer Price Index. Market prices from the province of Ontario, Canada’s largest province, were used for drugs, devices, laboratory services, physician services, and the cost of other health care professionals. Existing costing studies were used as the source of unit costs for emergency room visits and for hospitalizations. In the case of hospitalizations, the costing study (the Ontario Case Costing Project) was a comprehensive study of multiple hospitals and included costs for capital equipment, buildings, and land as well as for operating costs. Time losses, both work time and non-work time, were valued at the Canadian average industrial wage rate.

Consequences were valued in terms of scores improved on outcome instruments (WOMAC, SF-36, HUI3), patients improved, and QALYs gained. The latter two allowed the authors to calculate an incremental cost-effectiveness ratio (cost per additional patient improved) and an incremental cost-utility ratio (cost per additional QALY gained), and were necessary and appropriate to the objectives of the study. The definition of ‘patient improved’ was based on improvements in the patient’s WOMAC score that met or exceeded the pre-determined minimum clinically important difference established in advance by the clinical investigators. The WOMAC score, and hence the CEA, is focused on the index knee. The calculation of QALYs was based on the patient’s HUI score, and, thus, represented a measure of the health-related quality of life of the whole patient. The CUA, thus, is focused on the whole patient. The HUI score itself is based on community preferences, and this is consistent with the recommended source of preference weights for use in societal-perspective CUAs.

7. Were costs and consequences adjusted for differential timing?

__YES X NO __CAN’T TELL

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