Comparative Effectiveness, Cost-Effectiveness Analysis, Cost-Benefit Analysis

Question 1

A county government has a fixed budget that shall be used for improving pedestrians’ safety. Option A is the associated construction and intervention for children and Option B is for the senior. Suppose both options have the same costs and can save the same amount of human lives from accidents in a year. Based on the human capital approach, discuss which option is more beneficial.

Question 2

An ophthalmologist conducted a cost-effectiveness (cost-utility) analysis to compare lacer-assisted cataract surgery (LCS) versus conventional phacoemulsification cataract surgery (PCS). After considering all types of costs and the risk of complication, the estimated cost and QALYs per patient on average was below:

Calculate the incremental cost-effectiveness ratio. Which type of surgery do you suggest based on the economic evaluation? Suppose we use $50,000/QALY as a threshold.

Question 3

The Mayer of UMUC concerns about the increasing trend of Type 2 Diabetes in the town.  He is thinking about targeting pre-diabetes people and providing some interventions to reduce the number of new diabetes cases developed. Based on the record, about 1,200 people in this town are found to have pre-diabetes during their annual health check-ups.

Pre-diabetes means that an individual’s blood sugar level is higher than normal but not yet high enough to be type 2 diabetes. One clinical definition to identify pre-diabetes individuals is using the level of A1C, the measure of blood glucose. Diabetes is diagnosed at an A1C of greater than or equal to 6.5%.  A healthy individual has an A1C <5.7%. An individual with A1C between 5.7%-6.5% is considered pre-diabetes. If individuals with pre-diabetes do not take care of their living style well, they are possible to develop diabetes in the coming years. Once people develop diabetes, a substantial cost will be spent on treatment by patients. If people were found to have pre-diabetes through their annual health checkups, their doctors may advise them healthy diet or living style. However, no clinical treatment is provided.

Mayer’s Smart Team proposes two intervention programs:

Plan A: Through the referral by primary doctors in the town, people with pre-diabetes are invited to be enrolled in a “Diabetes Awareness Boot Camp” held at Community Center. The boot camp will provide 6 times of activities in total (2 times per month). For each time, the program offers a 3-hour lecture and demonstration including knowledge of diabetes, guidance on a healthy diet, and exercise that can be done at home. This program can enroll up to 150 people. After the 3-month intervention, enrollees will be followed-up by phone interviews every 3 months. Enrollees are required to take a blood test one year after enrollment to update their diabetes status.

Plan B: Through the referral by primary doctors in the town, people with pre-diabetes are invited to download an App on their mobile phones for free. This App is developed by Mayer’s team and will provide short articles and videos regarding knowledge of diabetes, guidance on a healthy diet, and exercise demonstration. The articles and videos are provided every week for one year. The App has no download limit.  Enrollees are required to take a blood test one year after enrollment to update their diabetes status.

A pilot program has been conducted for each plan to test its feasibility and to collect information about the cost and consequences from small samples.

Now, you are asked to develop an economic evaluation regarding which program should be chosen.

1. Which type of economic evaluation do you propose to use? (cost-effectiveness analysis vs cost-benefit analysis)  Justify your decision.
2. What is the perspective of this economic evaluation that you would propose? (Government perspective, or societal perspective, or other) Justify your decision.
3. For each option, list any possible cost item you need to collect.
4. Based on the type of economic evaluation you chose at (1), identify an indicator for the measure of the consequence. Justify your decision.
5. From (4), list any possible information that you need to measure the consequence for each option.
6. If you have a chance to talk with Mayer’s Smart Team, is there anything you want to ask for clarification? (optional)