Question

Capstone Case H: Cost-Effectiveness Analysis of Type II Diabetes

Diabetes is a major health problem, particularly for the millions of Americans with undiagnosed diabetes, for whom treatment and glycemic control could substantially reduce the onset of complications of this disease. The CDC Diabetes Cost-Effectiveness Group has published a number of articles based on cost-effectiveness analyses (CEA) using a sophisticated Markov simulation model. This probability- based model predicts the onset of diabetes in a hypothetical cohort of patients and follows them as they transition into the various disease states associated with complications and ultimately death. The first analysis (1998) estimates the cost-effectiveness of one-time opportunistic screening (i.e., done during routine contact with a health system). Two cohorts were used in this study, (1) a hypothetical population without diabetes assigned to either opportunistic screening or current clinical practice, and (2) a hypothetical cohort of 10,000 newly diagnosed diabetics who are followed for the development of major complications under the two screening alternatives. The second analysis (2002) estimates the cost-effectiveness of three interventions for the hypothetical cohort of 10,000 newly diagnosed diabetics: (1) intensive glycemic control; (2) intensive hypertension control; and (3) reduction in serum cholesterol. Hoerger and colleagues (2004) use the CDC Markov model to estimate the cost-effectiveness of two screening strategies: (1) diabetes screening targeted at those individuals with hypertension and (2) universal diabetes screening.

Questions

1. What is the difference between cost–benefit, cost-effectiveness, and cost–utility analysis?

2. What is the relationship between cost and effectiveness? Does more effectiveness always cost more money?

3. When doing CEA it is important to identify the perspective from which the analysis is conducted. In other words, from whose perspective are the costs and benefits recognized? What are the different perspectives? With the diabetes CEA, a single-payer perspective is assumed. What does this mean, and what kinds of costs are ignored?

4. What kinds of costs are usually included in a CEA? The diabetes CEA included screening costs, treatment costs, diabetes intervention costs, and diabetes complication costs. Under what category of costs would screening and treatments fall?

Answer 1

Ans) difference between cost benefit and cost effectiveness and cost utility:

Cost effective analysis:

Application to a wide range of possible clinical outcomes.can be used to compare treatments with the same outcomes.

Typically retrospective and use for evaluating discrete interventions.

Cost utility analysis:

Enables a broad range of outcomes to be combined in one summary outcomes.cosiders patient preferences for the outcomes.

Cost benefit analysis:

Compare programs with different outcomes.access the return of investment.cost and benefits expressed in monetary units.

Typically prospective and used for major capital investment.

2) difference between cost and effectiveness:

Effective is about doing the right things,while being efficient is about doing things right.cost effective is something that is good value,where the benefits and usage are worth at least what is paid for them .

3)ans)cost effectiveness analysis of a hypothetical cohort of individual living on the US,aged 25 years of olders who were newly diagnosed as having type 2diabetes.

Costs measured from the perspective of the health care system,and outcomes were measured.in the markov framework,a series of patients cohort newly diagnosed as having diabetes progressed through the model.

4)ans)

1) standard treatment cost is the cost of conventional glycemic control for all patients and moderate hypertension control for the patients with hypertension.

On average intensified hypertension control reduce complications cost by us dollars 4836 during the patients life time.

Interventions cost was IS dollar 3708.

Standard treatment cost increased by US dollar 351,because life expectancy increased.