CiNii 図書 - Designing and conducting cost-effectiveness analyses in medicine and health care

The field of cost-effectiveness analysis has lacked an entry-level textbook until now. Designing and Conducting Cost-Effectiveness Analyses in Medicine and Health Care is a hands-on guide for conducting economic analyses that closely follows the recommendations of the Panel on Cost-Effectiveness in Health and Medicine. Step by step, Dr. Muennig outlines the theory and practice of cost-effectiveness and shows how to develop an original research question, retrieve data, design a decision analysis tree, calculate quality-adjusted life years, and test for error in analysis. The book provides clear and detailed instruction and includes a review of the epidemiological and biostatistical skills students need to conduct cost-effectiveness analyses. While the book is designed for students, it includes advanced topics for policymakers, community health experts, and preventive medicine residents who are interested in the field. The book uses a worked example to walk the reader through the process of designing and conducting an analysis and provides links to all of the major Internet-accessible sources of government data. This book will be a welcome addition to the library of students and seasoned researchers alike.

Acknowledgments
List of Tables, Figures, and Exhibits
Tables
Figures
Exhibits
Preface
How to Use this Book
A Note on Methods
1 Introduction to Cost-Effectiveness
What Is Cost-Effectiveness Analysis?
Elements of Cost-Effectiveness Analysis Why Conduct Cost-Effectiveness Analysis? Scope and Aims of Cost-Effectiveness Analysis
Cost-Effectiveness Analysis and Policy
Making Comparisons Across Diseases Do Cost-Effectiveness Analyses Lead to Policy Changes?
Principles of Cost-Effectiveness Analysis
The Perspective of a Cost-Effectiveness Analysis The Cost-Effectiveness Ratio The Numerator of the Cost-Effectiveness Ratio The Denominator of the Cost-Effectiveness Equation Allocating Costs in the Cost-Effectiveness Ratio Interpreting the Cost-Effectiveness Ratio Comparing Interventions Defining the Comparator Interpreting Incremental Changes in Cost and Effectiveness.Other Types of Analyses
Cost-Effectiveness Versus Cost-Utility Analysis Cost-Benefit Analysis Cost-Minimization Analysis Burden of Disease Analysis
2 Developing a Research Project
The Ten Steps to a Perfect Research Project
Developing a Research Question
Designing Your Analysis
Step 1: Learn About the Disease Step 2: Chart Out the Course of the Disease Step 3: List the Data Elements That You Will Need
3 Working with Data
Overview
Review of Rates
Prevalence Versus Incidence The Relationship Between Risks and Rates Risk over a Long Period of Time
Understanding Error
Common Types of Error Managing Error in Cost-Effectiveness Analysis Frequency Distributions and Random Error
Calculating Weighted Means
Evaluating Study Limitations
Review of Medical Study Designs Evaluating the Medical Literature
4 Finding the Data You Need
Overview
Finding Information in the Medical Literature
Using Electronic Datasets
Finding the Electronic Data That You Need Which Dataset Should You Use? Using Data Extraction Tools Using Printed Tabulations of Electronic Data Understanding Error in Electronic Data
Using Data from Unpublished Research Projects
Using Data from Piggybacked Studies
Using Expert Opinion
Organizing Your Data
Summarizing Journal Articles Summarizing Data
5 Working with Probabilities
Overview
Incidence and Prevalence
Incidence Rate of Influenza-Like Illness.Secondary Transmission of Infectious Disease
Secondary Transmission of Influenza
Duration of Illness
Duration of Influenza-Like Illness
Efficacy and Measures of Risk
Bias in Screening Interventions Efficacy of Strategies to Prevent Influenza-Like Illness
Laboratory Test Data
Laboratory Testing for Influenza
Distribution of Disease
Distribution by Age Distribution by Stage Distribution by Gender, Race, and Socioeconomic Status Other Considerations Regarding the Distribution of Diseases Distribution of Influenza-Like Illness
Secondary Complications of Illness
Secondary Complications of Influenza-Like Illness
Medical Care Utilization
Rates Obtained from Electronic Data. Hospitalization Data for Influenza-Like Illness Ambulatory Care Data for Influenza-Like Illness
Side Effects
Side Effects Due to Vaccination or Treatment
Health-Related Quality of Life Scores
Obtaining Scores from Published Lists Generating HRQL Scores Using Instruments
Mortality Data
Mortality Among Persons with Influenza-Associated Conditions
6 Working with Costs
Overview
Opportunity Costs Three Steps to Estimating Costs Micro-Costing and Gross-Costing
Measuring Changes in Costs
Fixed Costs and Variable Costs Friction Costs and Transfer Payments
Using Diagnosis Codes
Future Medical Costs
Adjusting Costs
Adjusting for Inflation Calculating Cost-to-Charge Ratios Estimating the Cost of Ambulatory and Laboratory Services Discounting Future Costs
Assessing the "Relevancy" of Cost Data.Determining Which Costs to Include
Hospital and Ambulatory Costs Time Costs Transportation Costs Side Effects Medication Costs Caregiver Costs
7 Constructing a Model
Introduction to Decision Analysis
Types of Decision Analysis Models Constructing Simple Decision Analysis Models
Building the Influenza Model
Defining the Initial Branches Defining Variables in the Decision Analysis Model Entering Formulas Into the Decision Analysis Model Defining Terminal Nodes Defining Ambulatory Care Needs Secondary Complications Defining Antibiotic Use and Side Effects Defining Hospitalization Costs Patient Compliance Final Costs
8 Working with Quality of Life Measures
Overview
Framework
Who Should Valuate HRQL?
Deriving HRQL Scores
Using Preference-Weighted Generic Instruments HRQL Scores Generated from Large Health Surveys Using Disability-Adjusted Life Years
Things to Consider Regarding HRQL Scores
The Effect of Age on HRQL The Effect of Disease Stage on HRQL The Effect of an Intervention on HRQL Use of HRQL Scores in Diverse Populations Direct Versus Indirect HRQL Scores
9 Calculating Quality-Adjusted Life Years
Overview
Using the Life Table Method Charting the Lifetime Health Path of Your Cohort Using the Summation Method Using the DALY Method
Calculating QALYs in the Sample Analysis
Calculating HRQL Scores for Influenza-Like Illness Calculating Years of Life Lost Calculating QALYs in the Vaccination Arm Calculating QALYs in the Treatment Arm Incremental Cost-Effectiveness of Each Intervention Using QALYs in Decision Analysis Models
10 Conducting a Sensitivity Analysis
Overview
One-Way Sensitivity Analysis
Using One-Way Sensitivity Analyses to Validate a Model Answering Secondary Questions Using One-Way Sensitivity Analyses Determining "Plausible" High and Low Values.Two-Way Sensitivity Analysis
Analysis of Influence
Determining the Plausible Range of Each Variable Generating an Influence Diagram
Monte Carlo Simulation
How Monte Carlo Simulations Work Defining Distributions Conducting a Monte Carlo Simulation
11 Preparing Your Study for Publication
Overview
Content and Structure of Cost-Effectiveness Articles
Introduction Methods Results Discussion The Technical Appendix
Publishing Your Research
What Editors Want Choosing the Appropriate Journal
12 Advanced Concepts
Overview
Working with Measures of Risk
Bayes' Theorem
Generating Life Tables
Calculating QALE Using Published Data Generating QALE Using Electronic Data
Using Markov Models
Markov States How Markov Models Work Benefits of Markov Modeling
Appendix One: Solutions to Exercises
Chapter One Chapter Three Chapter Four Chapter Five Chapter Six Chapter Nine Chapter Ten
Appendix Two: Journal Summaries
Appendix Three: Census Tables
Appendix Four: HRQL Scores Derived from the Years of Healthy Life Measure
Appendix Five: Life Tables and Quality-Adjusted Life Tables
Appendix Six: The EuroQol Instrument
References
The Author
Index.

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Designing and conducting cost-effectiveness analyses in medicine and health care

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