Difference between revisions of "Talk:Economic evaluation"
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== Comments == | == Comments == | ||
| − | {{comment|K2 |Should willingness to pay/QALY be at the same level as applied in health care in Finland, i.e. 50 000-66 000 €/QALY? See eg. Soini et al 2012, Leussu 2011. | + | {{comment|K2 |Should willingness to pay/QALY be at the same level as applied in health care in Finland, i.e. 50 000-66 000 €/QALY? See eg. Soini et al 2012, Leussu 2011.|--Pfizer Oy, 2014-08-27 13:47:39 - R upload}} |
| − | |--}} | ||
| − | --[[User:Heini|Heini]] ([[User talk:Heini|talk]]) 12:35, 2 September 2014 (UTC) In Finland, there is no threshold for the cost of an additional quality-adjusted life-year. In the light of recent experience of varicella vaccination programme the decision makers’ willingness to pay for a QALY was not 50 000-66 000 euros. From the health care payers perspective varicella vaccination programme was cost-effective (14 600 euros / QALY) and from the societal perspective it was cost-saving. There are favourable recommendations of experts (Expert group, National Advisory Committee for Vaccination) and even a decision of Ministry of Social Affairs and Health to propose Government funding for varicella vaccination as part of the national immunization programme. However, Varicella vaccination has not yet been approved in the Government's budget proposal. | + | : --[[User:Heini|Heini]] ([[User talk:Heini|talk]]) 12:35, 2 September 2014 (UTC) In Finland, there is no threshold for the cost of an additional quality-adjusted life-year. In the light of recent experience of varicella vaccination programme the decision makers’ willingness to pay for a QALY was not 50 000-66 000 euros. From the health care payers perspective varicella vaccination programme was cost-effective (14 600 euros / QALY) and from the societal perspective it was cost-saving. There are favourable recommendations of experts (Expert group, National Advisory Committee for Vaccination) and even a decision of Ministry of Social Affairs and Health to propose Government funding for varicella vaccination as part of the national immunization programme. However, Varicella vaccination has not yet been approved in the Government's budget proposal. |
| + | {{comment|K3 |In the latest published FinIP data for pneumonia the data seem to show a higher than expected effeciveness for PCV10. We want to suggest that this data should be cosidered in light of a recent study in Sweden where PCV10 and PCV13 are both used in a real life setting in the same healthcare system. From this study, based on the Swedish National Inpatient Registry held by the National Board of Health and Welfare, it was found that PCV13 has significanlty lower pneumonia rates in infants and that PCV13 may save more in-patient cost due to pneumonia in infants compared to PCV10. Ref. Berglund A., Ekelund M., Nyman L., poster from ISPPD-9.|--Pfizer Oy, 2014-08-27 13:47:39 - R upload}} | ||
| − | + | '''Question: | |
| − | |||
| + | * "The health benefit (effectiveness) of the pneumococcal infant immunisation programme is assessed by the expected gain in Quality-Adjusted Life Years (QALYs), corresponding to the expected reduction in the annual number of invasive pneumococcal disease in the whole Finnish population." | ||
| + | :: {{attack|# |PCV programmes have been demonstrated to deliver much broader public health and economic benefits which extend beyond reduction of the invasive disease. | ||
| + | ::While we acknowledge that the it may be difficult to adjust the epidemiological model to assess the impact and benefits of prevention of respiratory infection episodes, including pneumonia and acute otitis media related endpoints, which effectively represent majority of the vaccine preventable disease burden (e.g.Palmu, ESPID 2014, poster), it is imperative that the cost effectiveness analyses take into account these endpoints. | ||
| + | ::To consider only IPDs would distort the cost-effectiveness analysis and by ignoring the majority of cost savings would violate the procurement law requirement that the selection criteria must have economic relevance to the contracting entity. | ||
| + | ::The applicants should have the opportunity to submit their proposal for assumptions including scientific justification and/or to provide alternative models for consideration. | ||
| + | ::Further, as indicated in the section “Comparison criteria” the assumption for serotype specific vaccine effectiveness for vaccine and vaccine-related types should be based on available clinical evidence, as far as possible. | ||
| + | |||
| + | ::In consequence, some parameters explored in the sensitivity analysis should be rather considered as a base case assumptions. | ||
| + | |||
| + | ::It is proposed to invite applicants to address such issues in the tender submissions.|-- GSK 13:17, 3 September 2014 (UTC)}} | ||
Revision as of 13:17, 3 September 2014
Comments
--K2 : Should willingness to pay/QALY be at the same level as applied in health care in Finland, i.e. 50 000-66 000 €/QALY? See eg. Soini et al 2012, Leussu 2011. --Pfizer Oy, 2014-08-27 13:47:39 - R upload
- --Heini (talk) 12:35, 2 September 2014 (UTC) In Finland, there is no threshold for the cost of an additional quality-adjusted life-year. In the light of recent experience of varicella vaccination programme the decision makers’ willingness to pay for a QALY was not 50 000-66 000 euros. From the health care payers perspective varicella vaccination programme was cost-effective (14 600 euros / QALY) and from the societal perspective it was cost-saving. There are favourable recommendations of experts (Expert group, National Advisory Committee for Vaccination) and even a decision of Ministry of Social Affairs and Health to propose Government funding for varicella vaccination as part of the national immunization programme. However, Varicella vaccination has not yet been approved in the Government's budget proposal.
--K3 : In the latest published FinIP data for pneumonia the data seem to show a higher than expected effeciveness for PCV10. We want to suggest that this data should be cosidered in light of a recent study in Sweden where PCV10 and PCV13 are both used in a real life setting in the same healthcare system. From this study, based on the Swedish National Inpatient Registry held by the National Board of Health and Welfare, it was found that PCV13 has significanlty lower pneumonia rates in infants and that PCV13 may save more in-patient cost due to pneumonia in infants compared to PCV10. Ref. Berglund A., Ekelund M., Nyman L., poster from ISPPD-9. --Pfizer Oy, 2014-08-27 13:47:39 - R upload
Question:
- "The health benefit (effectiveness) of the pneumococcal infant immunisation programme is assessed by the expected gain in Quality-Adjusted Life Years (QALYs), corresponding to the expected reduction in the annual number of invasive pneumococcal disease in the whole Finnish population."
- ⇤# : PCV programmes have been demonstrated to deliver much broader public health and economic benefits which extend beyond reduction of the invasive disease.
- While we acknowledge that the it may be difficult to adjust the epidemiological model to assess the impact and benefits of prevention of respiratory infection episodes, including pneumonia and acute otitis media related endpoints, which effectively represent majority of the vaccine preventable disease burden (e.g.Palmu, ESPID 2014, poster), it is imperative that the cost effectiveness analyses take into account these endpoints.
- To consider only IPDs would distort the cost-effectiveness analysis and by ignoring the majority of cost savings would violate the procurement law requirement that the selection criteria must have economic relevance to the contracting entity.
- The applicants should have the opportunity to submit their proposal for assumptions including scientific justification and/or to provide alternative models for consideration.
- Further, as indicated in the section “Comparison criteria” the assumption for serotype specific vaccine effectiveness for vaccine and vaccine-related types should be based on available clinical evidence, as far as possible.
- In consequence, some parameters explored in the sensitivity analysis should be rather considered as a base case assumptions.
- It is proposed to invite applicants to address such issues in the tender submissions. -- GSK 13:17, 3 September 2014 (UTC)
Ajattelimme Karin kanssa, että nykyinen epidemiologinen malli-ohjelmakoodi toimii hyvin ja sen voisi jättää suunilleen nykyiselleen. Taloudellinen malli perustuu epidemiologisen mallin ennusteisiin, mutta siihen tarvitaan 101-luokkainen ikäluokitus. Taloudellisen arvioinnin sivulla voisi siis olla kokonaan oma koodinsa jossa tehdään uusi ennuste tällä tiheämmällä luokituksella. Tai sitten epidemiologista mallia kutsutaan talousmallin sivulta - miten vain.
Olen nyt ladannut Opasnettiin alla olevaan muuttujaan 101-ikäluokkaisen aineiston.
http://fi.opasnet.org/fi/Special:Opasnet_Base?id=op_fi4433.pneumokokki_vaestossa
Tämä data on myös liitteenä "IPD_data.dat" (101*27 taulukko).
IPD= tapausten lukumäärä Suomessa per vuosi. Huom 1: Tiedostossa "IPD_data.dat" on kokonaislukuja, jotka tulee jakaa 1000:lla, jotta saadaan tapausten lukumäärä Suomessa per vuosi. Huom 2: tässä aineistossa carriage on ikäluokkakohtainen serotyyppijakauma, jonka summa on joka ikäluokassa 1000 (siis kantajuuosuudet promilleina). Tämä ei haittaa, koska mallissa ratkaisevia ovat vain suhteelliset kantajuusosuudet.
Tämän datan pitäisi sopia nykyiseen epidemiologisen mallin koodiin yhtä lailla kuin nykyinen kahden ikäluokan datakin.
(sivuhuomautus: Jostakin kumman syystä onnistuin kyllä ajamaan vastaavanlaisen 7 luokan datan (http://fi.opasnet.org/fi_wiki/index.php?title=Markunkoesivu&oldid=25237) mutta tästä 101-luokkaisesta versiosta koodi ei pitänyt.)
Ovariable VacIPD tuottaisi siis taloudellista mallia varten 101-pituisen vektorin joka vastaa IPD tapausten määrää Suomessa kussakin yhden vuoden pituisessa ikäluokassa per vuosi valittua rokotetta käytettäessä (tai ilman rokotuksia).
- ICER LASKENTA
Heiniltä saamme ensi viikon alussa 101-pituisen vektorin "QALYs_lost" (QALY=quality adjusted life year), joka vastaa kussakin ikäluokassa yhden IPD tapauksen keskimäärin tuottamaa QALY-menetystä ottaen huomioon kuoleman tai pysyvän haitan tms riskin ja näiden arvioidut elämänlaadun menetykset QALYina.
Samaten saamme vektorin "Costs_incurred", joka vastaa kussakin ikäluokassa yhden IPD tapauksen keskimäärin aiheuttamia terveydenhuollon kokonaiskustannuksia.
Siten rokotteen PCV_X jälkeen rokotusten ja IPD tapausten kustannukset ovat (sinisellä merkityt ovat 101-vektoreita)
Cost(PCV_X) = cost_of_vaccine(PCV_X) + sum(IPD(PCV_X) * Costs_incurred)
ja IPD tapausten haitat QALYina ovat
QALYs(PCV_X) = sum(IPD(PCV_X) * QALYs_lost)
R-koodi, jossa nämä lasketaan PCV10 ja PCV13 rokotteille on tiedostossa "Cost_Eff_model_run.R". Tässä käytetään funktiota "Vaccination", jota opasnetissä vastaa ovariable "VacIPD".
Koodissa käyttäjä antaisi siis inputtina kahden rokotteen, PCV_A ja PCV_B hinnat ja serotyypit ja saisi tuloksena taulukon:
QALYs gained incremental QALYs gained incremental costs ICER
------------------------- -------------------------- --------- ----------------
PCV_0 0 0 Cost(PCV_0) 0
PCV_A QALYs(PCV_0)-QALYs(PCV_A) QALYs(PCV_0)-QALYs(PCV_A) Cost(PCV_A)-Cost(PCV_0) inc.costs/inc.QALYs.g
PCV_B QALYs(PCV_0)-QALYs(PCV_B) QALYs(PCV_A)-QALYs(PCV_B) Cost(PCV_B)-Cost(PCV_A) inc.costs/inc.QALYs.g
missä PCV_0 on tilanne, jossa ei rokoteta. Tässä oletetaan, että A ja B on järjestetty siten, että QALYs(PCV_A)>QALYs(PCV_B).
