Question

The health authorities are considering the treatment alternatives for three types of diseases: heart disease, cancer, and infectious disease. Each year there are 10,000 new cases of heart disease, 10,000 new cases of cancer, and 5,000 new cases of infectious disease. For each diagnosis, there are a number of mutually independent treatment alternatives (including no treatment) as shown in the following table.

Treatment	Cost per treatment	QALY gained
Heart Disease
A	0	0
B	100	2
C	300	8
D	400	8
E	600	12
F	800	15
Cancer
G	0	0
H	200	8
I	400	10
J	500	12
K	600	9
L	700	14
M	800	15
Infectious Disease
N	0	0
O	100	2
P	350	4
R	650	6

a) identify all dominant treatment alternatives. Explain why each is dominant

b) Calculate the incremental cost, incremental QALY's, and ICERs for all economically rational strategies (ICER= incremental cost / incremental QALYs). Why are these considered economically rational?

c) using separate graphs for heart disease, cancer, and infectious disease, show the alternative treatment options, label the dominant options, and show the economically feasible alternatives. (Place QALYs on the vertical axis and cost per treatment on the horizontal axis)

d) the local health district has asked your opinion on the "best" strategy from a public health perspective (disease covered, treatment strategy). What do you tell them? How much will it cost?

Answer 1

a. and b. please see table below

Treatment	Cost per treatment	QALY gained	Cost / QALY	Incremental Cost	Incremental QALY	Incremental Cost / Incremental QALY
Heart Disease
A	0	0
B	100	2	50	100	2	50
C	300	8	38	200	6	33	Dominant alternative since the cost / QALY is the lowest
D	400	8	50	100	0	undefined	Economically irrational from the standpoint of the patient since there is no incremental QALY with additional cost
E	600	12	50	200	4	50
F	800	15	53	200	3	67
Cancer
G	0	0
H	200	8	25	200	8	25	Dominant alternative since the cost / QALY is the lowest
I	400	10	40	200	2	100
J	500	12	42	100	2	50
K	600	9	67	100	-3	-33	Economically irrational from the standpoint of the hospitals since incremental QALY cost negative
L	700	14	50	100	5	20
M	800	15	53	100	1	100
Infectious Disease
N	0	0
O	100	2	50	100	2	50	Dominant alternative since the cost / QALY is the lowest
P	350	4	88	250	2	125
R	650	6	108	300	2	150

c. pls see graphs below

d. the recommended treatments are C, H and O, respectively for Heart Disease, Cancer and Infectious Disease, as the Cost / QALY is the lowest for these. The total cost of treatment of all new patients each year is shown in the table below.

	Number of patients	Suggested Treatment	Cost / Treatment	Total Cost
Heart Disease	10,000	C	300	30,00,000
Cancer	10,000	H	200	20,00,000
Infectious Disease	5,000	O	100	5,00,000
Total	25,000			55,00,000