Valuing Health in Practice: Priorities QALYs and Choice by Douglas McCulloch

Author:Douglas McCulloch [McCulloch, Douglas]
Language: eng
Format: epub
Tags: Social Science, General, Sociology
ISBN: 9781351760317
Google: gyGzDwAAQBAJ
Publisher: Routledge
Published: 2019-09-30T05:13:18+00:00

The Approach of the Pharmaceutical Companies

Introduction

Evidence2 was presented to the Irish Centre for Pharmacoeconomics, supporting the adoption of two drugs (donepezil and rivastigmine) for funding by the Irish health service. The basic proposition was that adoption of the relevant drug would reduce health service costs by more than the cost of the drug. This conclusion rested on the idea that the drug would increase, or prevent the decline of, the Mini-Mental State Examination score (a clinical measure of outcome), which had been shown elswhere to be inversely related to institutional care costs. (A score of 30 means that all faculties are intact; as the disease progresses, the score declines.) Clinical outcome measures such as the MMSE can be useful in economic studies, but their reliability requirements may be different from those of QALY measures.

The articles used data from existing empirical studies which had tested the drug to provide outcome estimates; they relied on the multi-national randomised controlled trials which had been carried out to demonstrate the efficacy of the drugs. Separate studies of cost-effectiveness were not undertaken. The following common pattern could be identified in the studies:

Data collection: The drug is tested in a multi-national randomised controlled trial, lasting six months; MMSE data is collected, so that the impact of treatment between the beginning and end of the trial can be determined.

Cost Relationships: The relationship between the MMSE score and the cost of caring for AD patients can be determined from a secondary data source, generated in only one country, which is based on the proportions of patients institutionalised, and on the cost of care in institutions and in the community. (Expecting the same relationship to apply in a country which is not the one where the data was collected is problematic.)

Modelling: Extrapolations beyond the six-month trial, to between two and five years, are made, based on the RCT data, using survival functions or Markov analysis to determine the total time, during the period modelled, spent by each patient at a particular MMSE level.

Conclusion: Cost-effectiveness is demonstrated, because, given the assumptions made, the drug reduces the amount of time spent in an institution, and increases the amount of time spent in the community, so that there will be a reduction in the costs of care to the health service, or to society.

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