GOLD-Assembly Berlin GOLD-Assembly Berlin 20082008

J Mark FitzGeraldJ Mark FitzGerald

Health outcomes in COPD: the importance of economic

evaluations.J Mark FitzGerald

Carlo Marra

What it is!

The Holy Trinity Of Economics1. Resources are always and everywhere scarce, limited,

finite2. There are more beneficial programmes than we have

resources to do3. Choices must therefore be made and opportunities

(alternatives that we might have done) forgone– Applies to all levels of human decision making:

• Individual decisions (e.g., time allocation)• Health care decisions (AIDS vs. arthritis)• Macro economy decisions (defense vs. health)

– Efficient allocation of resources is where opportunity costs are minimized (i.e. we are getting the greatest value from our resources)

Health Economic Evaluations Are Just One Part of Health Economics

HealthHealth

EconomicsEconomicsHealth

EconomicEvaluation

Other topics in health economics:optimal size of hospitals, optimal payment for physicians, optimal level of co-payment by patients,….

Economic Evaluation

• Cost analysis– Do not include outcomes– Focus on resource utilization and costs– Not a full economic analysis

• Cost-benefit analysis– Both costs and effects measured in $– Rarely used in health

• Cost-effectiveness analysis (CEA)• Cost-utility analysis (CUA)

Cost Effectiveness Analysis

• Bang for buck– Compare programs in terms of their cost per

outcome (effect)• Single measure of effect

– Natural units (e.g. cases detected or prevented)

• Incremental form– Ratio of additional cost to additional benefit

Cost-Effectiveness Ratio

Compares a specific (new) intervention to a stated alternative (old) intervention

(Costnew – Costold) / (Benefitnew – Benefitold)

Incremental resources

required by the intervention

Incremental health effects gained by

using the intervention

Health economics and COPD:Health economics and COPD:

Overview of health economics.Overview of health economics.

Program evaluation.Program evaluation.

Cost effectiveness of interventions.Cost effectiveness of interventions.

Perspective:Perspective:

–GovernmentGovernment

–Patient.Patient.

–SocietySociety

Economic costs of Economic costs of COPD exacerbations COPD exacerbations

(1).(1).

RUSIC prospectively tracked all RUSIC prospectively tracked all exacerbations in a cohort of exacerbations in a cohort of COPD patients in one year.COPD patients in one year.

Data on exacerbations and Data on exacerbations and health care utilization health care utilization captured.609 subjects followed.captured.609 subjects followed.

678 Visits, 245 ED visits.678 Visits, 245 ED visits. 151 hospitalizations.151 hospitalizations.

Mittmann and FitzGerald et al Resp Med 2008

Economic costs of Economic costs of COPD exacerbations (2)COPD exacerbations (2)

Moderate exacerbation costs: Moderate exacerbation costs: $641 ($126 Out pt. and $515 ED)$641 ($126 Out pt. and $515 ED)

Severe exacerbation:$7,060 Severe exacerbation:$7,060 ± ± 10,826.10,826.

National burden related to National burden related to estimated 60,000 COPD estimated 60,000 COPD hospitalizations in Canada: hospitalizations in Canada: burden of ME and SE $646 burden of ME and SE $646 million.million.

Mittmann and FitzGerald et al Resp Med 2008

Annual cost of asthma in BC by year and cost component Cohort 155,000 asthma patients: 5-55. (2006 CAN$)

0

10

20

30

40

50

60

70

1996 1997 1998 1999 2000

Year

Costs (Million$)

Hospitalization

Medications

Physician/ED visits

FitzGerald and Marra

Annual cost of asthma by category

mild, controlled, 3% mild, uncontrolled,

11%

moderate, controlled, 2%

moderate, uncontrolled, 23%

severe, controlled, 1%

severe, uncontrolled, 60%

94% of costs caused by uncontrolled patients

FitzGerald and Marra

What it is not…