Reference no: EM133184599

Evaluation design

Assessment - Applied Economic Evaluation in Healthcare

Purpose
The purpose of this assignment is to assess and evaluate understanding and application of the principles of economic evaluations, budget impact analyses and preference elicitation measures.

Task
Your task is to perform the steps of an economic evaluation of the described health intervention, including steps of decision analytic modelling and budget impact analysis, by filling out the required information and answering the questions assigned.

Description
A new pharmacological treatment for uveitis, ‘NuVysion', has been approved by the PBS for clinical and quality standards for the prevention of blindness in high-risk patients who have an active disease flare, based on the results of a 2-year randomised controlled trial, with equal randomisation to NuVysion and best supportive care.

In the trial 30% of consented patients met the eligibility criteria: current active disease flare and diagnosed by their ophthalmologistas currently experiencing blindness. Blindness affected one-eye in 60% of patients and two-eyes in 40% of patients - these two groups were equally randomised across the two study arms.

Of those who were eligible and randomised to the NuVysion arm, 75% began and continued with the treatment for the duration of the trial. This proportion was not significantly different to the adherence rates for those randomised to best supportive care, nor was it significantly different across those with blindness in one eye or two.

Patients who had been treated with NuVysion had a reduction in risk of blindness compared with patients who received best supportive care (relative risk of blindness 0.2), over the 2-year trial duration.

The outcomes of the trial are summarised in the following table.

Table 1: Hypothetical trial data

Outcome	NuVysion	Best supportive care	Relative risk (95% CI)	Risk difference (95% CI)
Blindness (ie. treatment did not prevent blindness)	10/10,000 (0.1%)	50/10,000 (0.5%)	0.20 (0.05, 0.35)	-0.4% (-0.5%, -0.3%)

NuVysionneeds to be taken daily - each pack provides one monthof treatment. The costs to the Australian Government through the PBS subsidy are $120 per pack/month for NuVysionand $10 per month for best supportive care.

Part 1
a) Estimate the annual cost of blindness by quantifying health resource use (at least three resources) associated with the condition as well asvaluing the health resource use using available costing data. These are costs associated with the management of blindness, which is in addition to costs of NuVysion and best supportive care - which are treatments for uveitis.

Accordingly, the costs you identify may be broader than direct treatment costs. For example, just as uveitis can lead to blindness, if untreated, diabetes can lead to foot ulcers. A direct treatment cost of diabetes is insulin, whereas costs associated with the management of foot ulcers could include costs of dressings, as well as time off work.Fill out the following table by identifying relevant data sources and/or justifying your assumptions.

Table 2: Costing table

Identify (which resource items)	Quantify (how will you count them)		Value (how will you cost them)
	Units (e.g. frequency/ duration of use)	Source of utilisation estimates	Cost	Source of cost estimates

b) Identify 3 utility values for blindness and/or low vision from the published literature. Fill out the following table by identifying relevant data sources. Of these 3 values, pick one to use in an economic model and justify your selection.

Table 3: Utility table

Variable	Value	Source
Estimate 1
Estimate 2
Estimate 3

Part 2
a) Draw a decision tree to illustrate the treatment alternatives and possible outcomes (make sure to account for one-eye and two-eye blindness). You don't need to include the adherence rate in the decision tree (that is included for the BIA). Insert decision tree below - you can paste a photo of a hand-drawn tree or output from a computer software etc (a drawn diagram in excel is also fine).

For questions b), c) and d) assume only costs of treatment are included.

b) Calculate the incremental cost per blindness outcome prevented over the 2-year duration of the trial.

c)Calculate the incremental cost per QALY gained for NuVysion compared with best supportive care over the 2-year duration of the trial using the utility value you picked in Part 1.

d) Blindness is a life-long condition for patients. Calculate the incremental cost per QALY gained for NuVysion compared with best supportive care over 30 years assuming that there are no additional cases of blindness and the costs of treatment stop after two years but the costs of blindness continue for the life of the patient.

e) Are there any non-health outcomes that should be included in the economic evaluation? Provide a brief justification and if yes, provide examples.

f) How might you value the health and non-health outcomes associated with NuVysion treatment in monetary terms for a cost-benefit analysis?

g) List some possible attributes and levels that would be appropriate to include in a DCE that valued these health (and potentially non health) outcomes. Provide a short paragraph detailing the process you would use to ensue these attributes and levels are appropriate.

Part 3
Conduct a budget impact analysis of the cost of introducing NuVysion to the federal government. Fill out the following data by identifying relevant data sources and/or justifying your assumptions.

Table 1: Budget impact analysis

Variable	Value	Source/assumption
Total population
Disease prevalence
Proportion eligible for treatment
Uptake rate in eligible population
Total population		Calculated as total population x disease prevalence x proportion eligible for treatment x uptake rate
Number of packs per person per year
Cost per pack
Total cost		Calculated as total population x number of packs per person per year x cost per pack

Attachment:- Applied Economic Evaluation in Healthcare.rar