Cost-Effectiveness Analysis in HealthA Practical Approach
The field's bestselling reference, updated with the latest tools, data, and techniques Cost-Effectiveness Analysis in Health is a practical introduction to the tools, methods, and procedures used worldwide to perform cost-effective research. Covering every aspect of a complete cost-effectiveness analysis, this book shows you how to find which data you need, where to find it, how to analyze it, and how to prepare a high-quality report for publication. Designed for the classroom or the individual learner, the material is presented in simple and accessible language for those who lack a biostatistics or epidemiology background, and each chapter includes real-world examples and "tips and tricks" that highlight key information. Exercises throughout allow you to test your understanding with practical application, and the companion website features downloadable data sets for students, as well as lecture slides and a test bank for instructors. This new third edition contains new discussion on meta-analysis and advanced modeling techniques, a long worked example using visual modeling software TreeAge Pro, and updated recommendations from the U.S. Public Health Service's Panel on Cost-Effectiveness in Health and Medicine. Cost-effectiveness analysis is used to evaluate medical interventions worldwide, in both developed and developing countries. This book provides process-specific instruction in a concise, structured format to give you a robust working knowledge of common methods and techniques. Develop a thoroughly fleshed-out research project Work accurately with costs, probabilities, and models Calculate life expectancy and quality-adjusted life years Prepare your study and your data for publication Comprehensive analysis skills are essential for students seeking careers in public health, medicine, biomedical research, health economics, health policy, and more. Cost-Effectiveness Analysis in Health walks you through the process from a real-world perspective to help you build a skillset that's immediately applicable in the field.
List of Tables, Figures, and Exhibits xi Preface xxi Acknowledgments xxv About the Author xxvii Chapter 1 Introduction to Cost-Effectiveness 1 Learning Objectives 1 Overview 1 Why Cost-Effectiveness Is Useful 2 Elements of Cost-Effectiveness Analysis 4 The Average and Incremental Cost-Effectiveness Ratio 9 Why Conduct Cost-Effectiveness Analysis? 11 The Reference Case Analysis 14 Cost-Effectiveness Analysis and Policy 17 Summary 24 Further Readings 24 References 25 Chapter 2 Principles of Cost-Effectiveness Analysis 29 Learning Objectives 29 Overview 29 The Perspective of a Cost-Effectiveness Analysis 29 Capturing Costs 33 Capturing Quality 35 Interpreting the Cost-Effectiveness Ratio 39 Types of Economic Analysis 43 Summary 48 Further Readings 49 References 49 Chapter 3 Developing a Research Project 53 Learning Objectives 53 Overview 53 Eight Steps to a Perfect Research Project 53 Developing a Research Question 55 Designing Your Analysis 64 Summary 70 Further Readings 70 References 70 Chapter 4 Working with Costs 73 Learning Objectives 73 Overview 73 Opportunity Costs 74 Identifying Costs 77 Micro-Costing and Gross Costing 80 Getting Cost Data 82 Using Diagnosis Codes 84 Adjusting Costs 86 Costs Associated with Pain and Suffering 95 Assessing the ‘‘Relevancy’’ of Cost Data 97 Other Cost Considerations 98 Summary 102 Further Readings 103 References103 Chapter 5 Probabilities and Decision Analysis Models 105 Learning Objectives 105 Overview 105 The Idea Behind Decision Analysis 105 Probabilities 109 Decision Analysis Models 114 Summary 131 Further Reading 132 References 132 Chapter 6 Calculating Life Expectancy 135 Learning Objectives 135 Overview 135 Hand-Calculating Years Gained 135 Calculating Life-Years Lost Using Markov Models 140 Summary 150 Further Readings 151 References 151 Chapter 7 Working with Health-Related Quality-of-Life Measures 153 Learning Objectives 153 Overview 153 Framework 154 Deriving HRQL Scores 158 Other Considerations and Reminders 168 Using Disability-Adjusted Life-Years 171 Summary 172 Further Readings 173 References 173 Chapter 8 Calculating QALYs 177 Learning Objectives 177 Overview 177 Using the Summation Method 178 Using the Life Table Method 180 More On Discounting 189 Issues with QALYs 191 Calculating Incremental Cost-Effectiveness 192 Disability-Adjusted Life-Year (DALY) 195 Summary 196 Further Readings 196 References 196 Chapter 9 Conducting a Sensitivity Analysis 199 Learning Objectives 199 Overview 199 Performing a Sensitivity Analysis 199 Sensitivity Analysis 201 One-Way Sensitivity Analysis 203 Two-Way Sensitivity Analysis 207 Tornado Diagram 208 Multiway Sensitivity Analysis 210 Summary 222 Further Readings 222 References 223 Chapter 10 Preparing Your Study for Publication 225 Learning Objectives 225 Overview 225 Content and Structure of Cost-Effectiveness Articles 225 Title and Abstract 230 Introduction 231 Methods 233 Results 235 Discussion 238 Other 238 Technical Appendix 239 Figures and Illustrations 240 Summary 240 Further Reading 241 References 241 Chapter 11 Basic Concepts in Epidemiology and Application to Cost-Effectiveness Analysis 243 Learning Objectives 243 Overview 243 Review of Incidence 244 Understanding Error 252 Managing Error in Cost-Effectiveness Analysis 255 Calculating Weighted Means 261 Evaluating Study Limitations 263 Summary 274 Further Readings 275 References 276 Chapter 12 Finding the Data You Need 279 Learning Objectives 279 Overview 279 Finding Data in the Medical Literature 279 Grading Published Data 281 Using Electronic Datasets 282 Data Extraction Tools 290 Using Unpublished Data 293 Using Expert Opinion 294 Organizing Your Data 295 Summary 295 Further Readings 296 References 296 Chapter 13 A Worked Example 299 Learning Objectives 299 Overview 299 Helping Students Learn 299 Laboratory Exercise One: Building a Markov Tree 300 Laboratory Exercise Two: Comparing Interventions 320 Laboratory Exercise Three: The Cost-Effectiveness of Health Insurance 333 Laboratory Exercise Four: Sensitivity Analysis 344 Summary 358 Appendix A Answer Key to Exercises 359 Appendix B Life Expectancy and Quality-Adjusted Life Expectancy Tables 375 Appendix C EQ-5D-5L Health Questionnaire (English Version for the United States) 379 Appendix D Diagnosis, Charges, Medicare Reimbursement, Average Length of Stay, and Cost-to-Charge Ratio by Diagnosis-Related Groups, 2011 383 Glossary 419 Index 431
PETER MUENNIG, MD, MPH, is a professor in the Department of Health Policy and Management at Columbia University. MARK BOUNTHAVONG, PharmD, MPH is a pharmacoeconomist at the Veterans Affairs San Diego Health Care System and an adjunct faculty member of the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of California, San Diego.
The Bestselling Reference, Updated with the Latest Tools, Data, and Techniques Now in its third edition, the revised and updated Cost-Effectiveness Analysis in Health: A Practical Approach offers a comprehensive resource for evaluating the interventions and programs that are designed to improve health. Step by step, the authors reveal how to conduct practical cost-effectiveness analyses that has worldwide applications. Without relying on abstract theory or complicated models, Cost-Effectiveness Analysis in Health shows how to work with the fundamentals. The authors offer the information needed to develop a research question, find and evaluate data, build a decision model, stress-test the model, interpret the results, and summarize the findings in a report using the most up-to-date techniques and software. The text's illustrative exercises provide a guide through the process of obtaining electronic data, analyzing the medical literature, building a decision analysis tree, and conducting a sensitivity analysis. Cost-Effectiveness Analysis in Health includes: The principles of cost-effectiveness analysis The eight steps to a perfect research project Tools for evaluating the interventions and programs meant to improve health A review of probabilities and decision analysis models A basic introduction to biostatistics and epidemiology Information for preparing your study for publication The revised edition of Cost-Effectiveness Analysis in Health gives students a basic understanding of and the tools needed to conduct cost-effectiveness analysis.
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