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MGTECON 332/Health Research and Policy 392/Medical Information Science 432: Analysis of Costs, Risks and Benefits of Health Care

Professors: Jeremy Goldhaber-Fiebert, Douglas Owens

Required text:
Methods for the economic evaluation of health care programmes, 3rd ed., by Drummond, Sculpher, Torrance, O'Brien, and Stoddart, Oxford University Press, 2005
Business Library: 1 copy on Reserve
Lane Medical Library: RA410.5.D77 2005

Recommended texts:
Cost-Effectiveness in Health and Medicine, by Gold, Siegel, Russell, and Wenstein, Oxford University Press, 1996
Business Library: 2 copies on Reserve
Lane Medical Library: RA410.5 .C688 1996

Health Economics, 4th ed., ed by Phelps, Addison-Wesley, 2010.
Business Library: 1 copy on Reserve

Reading assignments by lecture topics:

"*" indicates that Class Notes are included for this class.

• Introduction
• Basic Approach to Cost Effectiveness and Cost-Benefit Analysis in Health Care*
• Valuing Output I: Quality-Adjusted Life Years (QALYs), Patient Preferences, and Outcomes
• Decision Analysis
• Introduction to Markov and Related Modeling Techniques
• HIV Detection Strategies
• Dominance and Extended Dominance: Diagnosis of Coronary Artery Disease
• Evaluating Efficacy*
• Cost Finding*
• Valuing Life: Human Capital and Contingent Valuation
• Probabilistic Sensitivity Analysis and Modeling
• The Importance of the Target Population: The Implantable Cardioverter Defibrillator
• Pharmaceutical Industry Perspective on CEA
• Vaccine Development: Value and Incentives

Introduction

Fuchs VR, Garber AM. The new technology assessment. New England Journal of Medicine, 1990; 323:673-677 (5pp.)

Drummond: Chapters 1 and 2, pp. 1-26 (Text, 26 pp.)

Singer P. Why We Must Ration Health Care. The New York Times Magazine , July 19. 2009 (8pp.)

Owens DK, Qaseem A, Chou R, Shekelle P; Clinical Guidelines Committee of the American
College of Physicians. High-value, cost-conscious health care: concepts for clinicians to evaluate the benefits, harms, and costs of medical interventions. Annals of Internal Medicine. 2011 Feb 1.

Optional Reading:

Garber, AM, Skinner, J. Is American Health Care Uniquely Inefficient? Journal of Economic Perspectives, 2008; 22(4): 27-50 (24 pp.)

Gold: Chapter 1, pp. 3-24 (Text, 21 pp.)

Basic Approach to Cost Effectiveness and Cost-Benefit Analysis in Health Care*

Enthoven AC, Garber AM: Economic Analysis of Health and Medical Technologies ad Practices, and other Public Programs. An Overview Outline. (Syllabus, 27 pp.)

Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Journal of the American Medical Association, 1996; 276: 1253-1258 (6 pp.)

Drummond: Chapter 3, sections 3.1-3.3 pp. 27-48 (Text, 22 pp.), Chapter 5, pp. 103-136 (Text, 34 pp.), Chapter 6, sections 6.1-6.2, pp. 137-147 (Text, 11 pp.) and Chapter 7, section 7.1, pp. 211-215 (text, 5 pp.)

Optional reading:

Gold: Chapter 8, pp. 247-271 (Text, 25 pp.)

Garber AM. Advances in cost-effectiveness analysis of health interventions, Chapter 4, pp. 181-221, in Culyer AJ, Newhouse JP, eds., Handbook of Health Economics, Volume 1A, Amsterdam: Elsevier Science B.V., 2000. (40 pp.)
* This chapter gives an overview of recent developments in cost-effectiveness analysis. It includes technical material written at the graduate economics level.

Valuing Output I: Quality-Adjusted Life Years (QALYs), Patient Preferences, and Outcomes

Tengs TO, Wallace A. One Thousand Health-Related Quality-of-Life Estimates. Medical Care, 2000; 38(6):583-637 (55 pp.)

Bell CM, Chapman RH, Stone PW, Sadberg EA, Neuman PJ. An off-the-shelf help list: a comprehensive catalog of preference scores from published cost-utility analysis. Medical Decision Making, 2001; 21:288-294 (7 pp.)

Drummond: Chapter 6, Sections 6.3 to en of chapter, p. 147-196 (Text, 50 pp.)
* After reading this chapter, please examine Tables 6.10 and6.11 and read the instructions for determining your Health Utilities Index mark3 classification score. At noon the day before class please measure your quality of well being.

Optional reading:

Gold: Chapter 4,pp. 82-134 (Text, 52 pp.)

Decision Analysis

Owens DK, Soc HC. Biomedical Decision Making: Probabilistic Clinical Reasoning. Chapter 3, pages 80-132 in Shortliffe and Cimino, eds., Biomedical Informatics: Computer Applications in Health Care and Biomedicine, 3rd edition. New York: Springer, 2006 (52 pp.)

Sculpher M, Fenwick E, Claxton K. Assessing Quality in Decision Analytic Cost-Effectiveness Models: A Suggested Framework and Example of Application. PharmacoEconomics, 2000; 17(5): 461-477 (17 pp.)

Optional reading:

Detsky, AS, Naglie G, Krahn MD, Naimark D, Redelmeier DA. Primer on medical decision analysis: Part 1- Getting started. Medical Decision Making, 1997; 17:123-125 (3 pp.)

Detsky AS, Naglie G, Krahn MD, Redelmeier DA, Naimark D. Primer on medical decision analysis: Part 2- Building a tree. Medical Decision Making, 1997; 17:126-135 (10 pp.)

Naglie G, Krahn MD, Naimark D, Redelmeier DA, Detsky AS. Primer on medical decision analysis: Part 3- Estimating probabilities and utilities. Medical Decision Making, 1997; 17:136-141 (6 pp.)

Krahn MD, Naglie G, Naimark D, Redelmeier DA, Detsky AS. Primer on medical decision analysis: Part 4- Analyzing the model and interpreting the results. Medical Decision Making, 1997; 17: 142-151 (10 pp.)

Introduction to Markov and Related Modeling Techniques

Sonnenberg F, Beck R. Markov models in Medical Decision Making: A Practical Guide. Medical Decision Making, 1993; 13 (4): 322-338 (17 pp.)

Optional reading:
Naimark D, Krahn MD, Naglie G, Redelmeier DA, Detsky AS. Primer on medical decision analysis: Part 5- Working with Markov processes. Medical Decision Making, 1997; 17:152-159 (8 pp.)

October 11, 5:00-7:00 (Location: C106)-- TreeAge Software Tutorial Session with Eva Enns

HIV Detection Strategies

Sanders GD, Bayoumi AM, SundaramV, Bilir SP, Neukermans CP, Rydzak CE, Douglass LR, Lazzeroni LC, Holodniy M, Owens DK. Cost effectiveness of screening for HIV in the era of highly active antiretroviral therapy. New England Journal of Medicine, 2005; 352(6): 570-85 (16 pp.)

Owens DK, Harris RA, Scott P, Nease RF. Screening surgeons for HIV infection: a cost-effectiveness analysis. Annals of International Medicine, 1995; 122:641-652 (12 pp.)

Optional reading:
Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians.  Screening for HIV in health care settings: A guidance statement from the American College of Physicians.  Annals of Internal Medicine 2009; 150:125-131 (8 pp.)

Dominance and Extended Dominance: Diagnosis of Coronary Artery Disease

Goldie, Sue J. and Gaffikin, Lynne and Goldhaber-Fiebert, Jeremy D. and Gordillo-Tobar, Amparo and Levin, Carol and Mahe, Cedric and Wright, Thomas C. (2005). Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries. New England Journal of Medicine. 353(20):2158-2168.

Gold: Chapter 3, pp. 54-81 (Text, 27 pp.)

Evaluating Efficacy*

U.S. Preventive Services Task Force. Current Processes of the U.S. Preventive Services Task Force: Refining Evidence-Based Recommendation Development . Annals of Internal Medicine, 2007; 147:117-122 (7 pp.)

Online version of updated methodology , see pp. 44-57

Enthoven AC: Part I--Overview of Technology Assessment and Research Designs, and Part II--An Introductory Overview of Selected Research Designs (Syllabus, 32 pp.)

Optional reading:

Phelps C. The methodologic foundations of studies of the appropriateness of medical care. New England Journal of Medicine, 1993; 329:1241-5 (5 pp.)

Cost Finding*

Drummond: Chapter 4, pp. 55-101 (Text, 47 pp.)

Optional reading:

Gold: Chapter 6, pp. 176-213 (Text, 37 pp.)

Valuing Life: Human Capital and Contingent Valuation

Drummond: Chapter 7, review section 7.1 and read the rest of the chapter, pp. 211-240 (Text, 30 pp.)

Optional reading:

Gold: Chapter 2, pp. 25-53 (Text, 28 pp.)

Schelling TC: The life you save may be your own. In SB Chase (Ed.) Problems in Public Expenditure Analysis, Brookings, Washington, 1968 (On reserve, 35 pp.)

Probabilistic Sensitivity Analysis and Modeling

Briggs AH, Goeree R, Blackhouse G, and O'Brien, B. Probabilistic Analysis of Cost-Effectiveness Models: Choosing between Treatment Strategies for Gastroesophageal Reflux Disease. Medical Decision Making, 2002; 22: 290-308 (19 pp.)

Claxton K, Sculpher M, McCabe C, Briggs A, Akehurst R, Buxton M, Brazier J and O'Hagan T. Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra. Health Economics, 2005; 14: 339-347 (9 pp.)

Optional reading:

Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Economics, 2001 Dec;10(8):779-87 (8 pp.)

The Importance of the Target Population: The Implantable Cardioverter Defibrillator

Sanders GD, Hlatky MA, Owens  DK. Cost-effectiveness of implantable cardioverter defibrillators. New England Journal of Medicine. 2005 Oct 6; 353(14):1471-80 (10 pp.)

Pharmaceutical Industry Perspective on CEA

Optional reading:
Sharpe P, Keelin T. How SmithKline Beecham Makes Better Resource-Allocation Decisions. Harvard Business Review, March-April 1998:76(2):45-57 (13 pp.)

See Pharmacoeconomic Guidelines Around the World

Vaccine Development: Value and Incentives

43 Ways to Save the World. The Economist, July 2 2005; 376(8433): 69-70 (2 pp.)

 

 

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