Review of Australian health economic evaluation – 245 interventions: what can we say about cost effectiveness?

Dalziel Kim, Segal Leonie, Mortimer, Mortimer Duncan

Description

There is an increasing body of published cost-utility analyses of health interventions which we sought to draw together to inform research and policy. Methods To achieve consistency in costing base and policy context, study scope was limited to Australian-based cost-effectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria. Results The median cost-effectiveness ratio was A$18,100 (~US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, in-patient interventions (median cost/QALY/DALY/LY all at ~A$9,000~US$6,500). Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY < A$3,700, < US$5,000). Interventions targeting younger persons < 25 years (median cost/QALY/DALY/LY < A$41,200) tended to perform less well than those targeting adults > 25 years (median cost/QALY/DALY/LY < A$16,000). However, there was also substantial variation in the cost effectiveness of individual interventions within and across all categories. Conclusion For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2008
• Nombre de lectures: 5
• Langue: English

Extrait

Cost Effectiveness and Resource Allocation

Research Review of Australian health economic evaluation – 245 interventions: what can we say about cost effectiveness? 1 1 1,2 Kim Dalziel , Leonie Segal and Duncan Mortimer*

BioMedCentral

Open Access

1 2 Address: Health Economics and Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia and Centre for Health Economics, Monash University, Melbourne, Australia Email: Kim Dalziel  [e-mail]; Leonie Segal  [e-mail]; Duncan Mortimer*  [e-mail] * Corresponding author

Published: 20 May 2008 Received: 1 November 2007 Accepted: 20 May 2008 Cost Effectiveness and Resource Allocation2008,6:9 doi:10.1186/1478754769 This article is available from: http://www.resourceallocation.com/content/6/1/9 © 2008 Dalziel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract Background:There is an increasing body of published costutility analyses of health interventions which we sought to draw together to inform research and policy.

Methods:To achieve consistency in costing base and policy context, study scope was limited to Australianbased costeffectiveness analyses. Through a comprehensive literature review we identified 245 health care interventions that met our study criteria.

Results:The median costeffectiveness ratio was A$18,100 (~US$13,000) per QALY/DALY/LY (quality adjusted life year gained or, disability adjusted life year averted or life year gained). Some modalities tended to perform worse, such as vaccinations and diagnostics (median cost/QALY $58,000 and $68,000 respectively), than others such as allied health, lifestyle, inpatient interventions (median cost/QALY/DALY/LY all at ~A$9,000~US$6,500). Interventions addressing some diseases such as diabetes and impaired glucose tolerance or alcohol and drug dependence tended to perform well (median cost/QALY/DALY/LY < A$3,700, < US$5,000). Interventions targeting younger persons < 25 years (median cost/QALY/DALY/LY < A$41,200) tended to perform less well than those targeting adults > 25 years (median cost/QALY/DALY/LY < A$16,000). However, there was also substantial variation in the cost effectiveness of individual interventions within and across all categories.

Conclusion:For any given condition, modality or setting there are likely to be examples of interventions that are cost effective and cost ineffective. It will be important for decision makers to make decisions based on the individual merits of an intervention rather than rely on broad generalisations. Further evaluation is warranted to address gaps in the literature and to ensure that evaluations are performed in areas with greatest potential benefit.

Background Because resources are limited not all potentially beneficial services can be funded. Choices must be made in allocat ing scarce resources. Economic evaluation can help inform resource allocation choices by comparing costs

and consequences of two or more alternatives. Compari sons between interventions will be more robust where they are country specific, at least in terms of input costs, which differ considerably between countries. To date Aus tralian economic evaluations have not been systemati

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