Introduction to Health Economic Evaluation Yot Teerawattananon, M.D., Ph.D.

Problems with use of health technology Efficacy (benefits) Safety Value for money (cost-effectiveness)—Social Ethical Institutional 2

John Stuart Mills Utilitarianism Happiness was the greatest goods Happiness and unhappiness can be measured in discrete units and calculated mathematically e.g. sum of happiness, subtracting the pain The goal is the production of maximal happiness, or utility 3

What counts as an “economic” evaluation? Often confusion with economic evaluation Clinical studies or trials Source: Drummond et al 2005 4

Types of economic evaluation Cost minimisation analysis (CMA) การประเมินผลต่างต้นทุน Cost effectiveness analysis (CEA) การประเมินต้นทุนประสิทธิผล Cost utility analysis (CUA) การประเมินต้นทุนอรรถประโยชน์ Cost benefit analysis (CBA) การประเมินความคุ้มทุน 5

Type of economic evaluation Nominator Denominator Cost-minimization $ - Cost-effectiveness Process or health outcome in natural unit e.g. mmHg Cost-utility Outcome in a common unit e.g. QALY, DALY Cost-benefit 6

ต้นทุน-ประสิทธิผลของเทคโนโลยีด้านสุขภาพบางชนิด ประเทศไทย 2550 ยา/เทคโนโลยี บาท/QALY สิทธิประโยชน์ Antiretroviral treatment vs. palliative care 26,000 Yes Prevention of vertical HIV transmission (AZT + NVP) vs. null 25,000 Statin (generic) in men >30% CVD risk vs. null 82,000 Cytomegalovirus retinitis: Gancyclovir vs. palliative 185,000 Antidiabetic: Pioglitazone vs. Rosiglitazone 211,000 No HPV vaccine at age 15 vs. Pap smear, 35-60 years old, q 5 years 247,000 Osteoporosis: Alendronate vs. calcium + vitamin D 296,000 Osteoporosis: Residronate vs. calcium + vitamin D 328,000 Peritoneal dialysis vs. palliative care 435,000 Hemodialysis vs. palliative care 449,000 Osteoporosis: Raloxifene vs. calcium + vitamin D 634,000 Osteoporosis: Calcitonin vs. calcium + vitamin D 1,024,000 HPV vaccine at age > 25 vs. Pap smear, 35-60 years old, q 5 years 2,500,000 Anemia in cancer patients: Erythropoitin vs. blood transfusion 2,700,000 Transtuzumab in breast cancer 5,051,000 อธิบาย GDP per QALY (why 200,000 baht per QALY) 7

Example of using HTA in price negotiation the analysis of pricing threshold of the HPV vaccine against the WTP threshold Vaccine price in Thai Baht In Fab 09 a company announced a price reduction of the vaccine to 7,000 Baht 8 Source: HITAP 2008