How do Italian pharmacoeconomists evaluate indirect costs
TL;DR: Italian pharmacoeconomists are far from reaching any consensus on methods for evaluating indirect costs, and methods need to be standardized particularly with respect to the parameters used to quantify productive time lost in monetary terms.
About: This article is published in Value in Health.The article was published on 2000-07-01 and is currently open access. It has received 17 citations till now. The article focuses on the topics: Indirect costs & Pharmacoeconomics.
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TL;DR: Considering the potential risk of vaccination, as well as unbalanced socioeconomic developments and significant differences in HAV infection through the whole country, the study suggests that universal childhood hepatitis A vaccination should be first administrated in provinces with the lowest infection level.
38 citations
01 Jan 2006
TL;DR: The cost minimisation approach has been presented to evaluate mosquito control programs at the local level where the policy analyst’s task is to minimise the overall social costs (that is, disease costs plus control costs).
Abstract: Insect pests (such as mosquitoes) and their associated impacts have become important social, economic and environmental health issues. Mosquitoes transmit diseases, are widely perceived as a nuisance and are becoming a serious health concern for the public. The incidence of contracting mosquito-transmitted diseases has markedly increased in recent decades in Australia (Russell 1994). Currently, Ross River virus is the most prevalent mosquito-transmitted viral disease in Australia with up to 8,000 cases reported annually (Curran et al. 1996). The absence of documented evidence about the full social costs of mosquito-transmitted diseases is a critical issue as there is currently no economic rationale underlying existing resource allocation for intervention programs.
This study of the full social costs of Ross River virus was conducted between April and July 2002. Demographic, health-state and disease-related data were collected using survey questionnaires for 201 notified Ross River virus victims from across Queensland. Two self-administered surveys were conducted at the time approximately onset and six months from onset while a phone survey was conducted at 12 months after onset. Direct impacts such as the costs of health care (medical consultations, pathology services and medicines), non health care resources (treatment-related transport) and indirect impacts such as the opportunity cost of lost productivity (due to disability and treatment-related waiting times) of the viral illness were recorded in the questionnaires and were valued using market prices. A non-market valuation method (willingness-to-pay), in conjunction with a self-assessed standard health measure (Short Form 36) were used to quantify more intangible health-related quality of life effects such as change in physical, mental and social functioning. Estimated full social costs of the disease were analysed across age and gender groups. Based on the mean cost estimates for the study sample, the total disease costs have been extrapolated by local government areas as the appropriate administrative areas. A wide range of social and economic costs of the virus has been addressed in this thesis. However, the derived costs cannot be summed into a total estimate as several of these values overlap in terms of coverage. Therefore, only the major cost components, with a minimum of overlap, have been used to estimate the aggregate social cost of the disease. Given the methodological and empirical limitations of the study, the most accurate estimate of the average per
capita full costs of Ross River virus in Queensland is estimated at $AUD (2002) 1,070 per case.
The estimate of the full social cost of Ross River virus disease can be a vital input for many relevant policy applications. For example, disease costs together with resource costs of current interventions, are essential inputs for ongoing economic evaluations of mosquito control programs at local level. In this thesis, the cost minimisation approach has been presented to evaluate mosquito control programs at the local level where the policy analyst’s task is to minimise the overall social costs (that is, disease costs plus control costs). These economic evaluations have substantial potential benefits to society in terms of the efficient allocation of scarce resources.
In addition, estimated disease cost is a significant input for economic impact assessment of regional disease outbreaks. It also can be used to highlight disease impact upon the economy and community and hence draw attention to the scale and scope of such problems to policy makers at all levels so that they can respond appropriately to the mosquito problem, and mosquito-transmitted diseases, as priority issues in the political agenda.
25 citations
TL;DR: The present study provides further estimates of the cost of schizophrenia treatment in Italian mental health services and highlights the variability in the single cost components across clinically defined subgroups of patients.
Abstract: The behavior that accompanies schizophrenia and related disorders interferes with professional and social activities. As a result, schizophrenia is one of the most costly psychiatric illnesses. Direct medical costs associated with schizophrenia were estimated from the Italian National Health Service perspective. This was a multicenter observational 1-year study conducted in 14 Italian community mental health centers (CMHCs). Eligible patients were those with a diagnosis of schizophrenia or schizoaffective or schizophreniform disorder who had been followed by the CMHCs for at least 2 years at study entry. Exactly 643 patients were enrolled in the study. The mean direct cost per year was ?6,964 (?27,025 for schizophrenia and ?6,587 for patients with related psychotic disorders) (1998 exchange rate U.S.$1 = ?1.121). The present study provides further estimates of the cost of schizophrenia treatment in Italian mental health services and highlights the variability in the single cost components across clinically defined subgroups of patients.
21 citations
Cites background from "How do Italian pharmacoeconomists e..."
...In the retrospective phase of the present study, differences in total costs for the 14 participating centers were estimated, taking into account the differences in case mix (Garattini et al. 2000)....
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...The Italian National Health Service (INHS) is a public service funded by general taxation that provides universal coverage and comprehensive health care free at point of delivery (Garattini et al. 2000)....
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TL;DR: Critically analyse the main key points for conducting an economic evaluation, underlining the main weaknesses of EE as pragmatic tools for public decision-making, particularly in the perspective of pharmaceutical pricing and reimbursement.
Abstract: Economic evaluation (EE) is still a historically young discipline in healthcare. Originally started as a technique for assessing investments in the public sector, EE has been applied to healthcare since the last decades of the previous century and disseminated rapidly to many countries, thanks partly to a successful English manual, which was later translated into many other languages. The first edition of the manual mainly referred to EE on health procedures, services or programmes, and not to products like drugs. Then, very soon, the Canadian State of Ontario and Australia issued the first pharmacoeconomic guidelines for drugs reimbursement, followed later by many Western European countries (e.g. The Netherlands, Norway, Portugal and Sweden). Last year the Dutch National Health Care Institute issued new guidance for EE in healthcare. Although the latest guidelines (Box 1) go beyond drugs (differently from the past), covering five further areas (prevention, diagnostics, medical devices, longterm care and forensics), pharmaceuticals are still the main field of application. Several elements of novelty reflect the methodological developments in EEs, two of which have been judged the most important recommendations for drugs: value of information analysis and indirect medical costs. Both concern EE ‘borderline’ subjects coping with uncertainty. The first is a statistical tool intended to be useful for assessing uncertainty related to the consequences of inappropriate decision-making in healthcare; the second concerns the unrelated future medical costs induced during the life years gained indirectly from a technology which prolongs the life of patients. In general, although we do not dispute that the new Dutch guidelines can be considered a scientific step forward in improving the requirements for EEs in healthcare, moving from good to better recommendations and still open to further improvement in the future, we still feel that health decisionmakers should be fully aware of the general intrinsic limits of EE that have been underlined in the last two decades, moving from theory to practice. Thus, here we critically analyse the main key points for conducting an EE, underlining the main weaknesses of EE as pragmatic tools for public decision-making, particularly in the perspective of pharmaceutical pricing and reimbursement.
20 citations
Cites background from "How do Italian pharmacoeconomists e..."
...This is a controversial and unsettled area since methods to quantify indirect costs still suffer major limitations and their application is open to discretion in practice.(16) Two methods are currently mentioned most for evaluating indirect costs....
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TL;DR: The study brought to light the wide variability in the single cost components across clinically defined groups of patients and found the cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.
Abstract: This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c 60). The average total cost of type 1 diabetes per patient per year ranged from 762 euro in group 2 (age 7.5%) to 1,060 euro in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from 423 euro in group 5 (age 60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.
20 citations
References
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01 Jan 1998
TL;DR: The second edition of the first edition of this book was published in 1987 as discussed by the authors, and the second edition includes new chapters on collection and analysis of data and on the presentation and use of data.
Abstract: We are witnessing a paradigm shift in the way medicine is practiced, taught, and evaluated. It was relatively recently that medicine knew no limits. New diagnostic procedures led to more medical and surgical procedures and to greater expense. It was assumed that patients would be the recipient of these advances. However, the uncontrolled costs of medical care and the poor documentation of patient benefit ushered in a new era of cost conscientiousness. Now, there is a need to show that medicine produces value for money. As a result, new methodologies such as cost-effectiveness analysis, cost-benefit analysis, and cost-utility analysis have become commonplace in medical journals. This has created a need to revise medical education and postgraduate training in order to accommodate new methodologies and new controversies. Within the last few years, several influential publications have emerged. Perhaps the most important of these is the book Cost-Effectiveness in Health and Medicine edited by Martha Gold and colleagues.1 This book summarizes the consensus of an expert panel convened to review cost-effectiveness analysis in health care. The Gold book covers the theory but does not teach the methods. Methods for the Economic Evaluation of Health Care Programmes by Michael Drummond and colleagues offers specific, step-by-step methodologies for conducting economic evaluations. This is the second edition of a book originally published in 1987. During the ten years between editions, there were very substantial advances in theory and methods for economic evaluations of health care programs. The revised edition brings the text up to date. Methods for the Economic Evaluation of Health Care Programmes arises from the teaching of health economics at McMaster University. The McMaster Centre for Health Economics and Policy Analysis is internationally regarded as a focal point for economic evaluations of health care. Among other advances, researchers at the Centre have produced a widely used methodology, known as the Health Utilities Index, for estimating the cost/utility of health programs. The book was originally developed for a course at McMaster and for a workshop offered by the McMaster faculty. The second edition adds one new author (Bernie O’Brien) who has more recently joined the McMaster faculty. The second edition also introduces substantial changes in the chapters on cost-effectiveness, cost-utility, and cost-benefit analysis. These are important improvements because of the profound methodological developments in these areas. In addition, the second edition includes new chapters on collection and analysis of data and on the presentation and use of data. These new chapters add discussion on the pros and cons of economic evaluations and on some of the difficulties in the interpretation of economic data. In addition, the second edition includes many more boxes and illustrations to facilitate the interpretation of the text. Perhaps the greatest contribution of the book is the very detailed presentation of cost/utility analysis. It is now common to offer discussions of the cost to produce a year of life adjusted for life quality. This is known as a quality adjusted life year (QALY). There are a variety of different methods for estimating QALYs. Nevertheless, QALYs estimated using different methods are often found in the same comparison or “league” table. This book goes into considerable detail in how QALYs are estimated and describes some of the methodological issues and problems in estimating these outcomes. Unlike other texts, the book provides systematic stepby-step instruction in how both costs and health benefits can be estimated. In summary, the role of health economics is becoming firmly established in the evaluation of health care programs. In combination with Gold and colleagues’ book,1 which provides a detailed theoretical discussion of economic analysis, Methods for the Economic Evaluation of Health Care Programmes offers systematic training in the application of economic methodologies. This book can serve as a basic text for students hoping to understand the complex methodologies of economic evaluation. In addition, the book is a handy reference for advanced practitioners of economic analysis.
6,537 citations
Book•
01 Jan 1996
TL;DR: 1. Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations 2. Theoretical Foundations of Cost-effectiveness Analysis 3. Framing and Designing the Cost- Effectiveness Analysis 4. Identifying and Valuing Outcomes 5. Assessing the Effectiveness of Health Interventions
Abstract: 1 Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations 2 Theoretical Foundations of Cost-Effectiveness Analysis 3 Framing and Designing the Cost-Effectiveness Analysis 4 Identifying and Valuing Outcomes 5 Assessing the Effectiveness of Health Interventions 6 Estimating Costs in Cost-Effectiveness Analysis 7 Time Preference 8 Reflecting Uncertainty in Cost-Effectiveness Analysis 9 Reporting Cost-Effectiveness Studies and Results Appendix A: Summary of Recommendations for the Reference Case Appendix B: Cost-Effectiveness of Strategies to Prevent Neural Tube Defects Appendix C: The Cost-Effectiveness of Dietary and Pharmacologic Therapy for Cholesterol Reduction in Adults
5,617 citations
TL;DR: These estimates are considerably lower than estimates based on the traditional human capital approach, but they better reflect the economic impact of illness.
1,133 citations
TL;DR: Neither the friction-cost approach nor the QALY approach can be recommended over the more commonly used human capital- cost approach for estimating the indirect costs of a disease in economic evaluations from a societal perspective.
Abstract: This article describes the components that should be included as indirect costs to be consistent with economic theory in studies conducted from a societal perspective The recently proposed method of how to estimate indirect costs, the friction-cost approach, is shown to exclude many aspects of these indirect cost components Furthermore, it is demonstrated that this approach rests on very strong assumptions about the individual’s valuation of leisure and about the labour market This approach does not, in most realistic circumstances, have a foundation in economic theory It also shows that all indirect costs cannot be assumed to be included in the individual’s reported utility weight for a health state [used to determine quality-adjusted life-year (QALY) values], as recently suggested by the US Panel for Cost-Effectiveness Analysis of Health and Medicine Therefore, to be consistent with economic theory, neither the friction-cost approach nor the QALY approach can be recommended over the more commonly used human capital-cost approach for estimating the indirect costs of a disease in economic evaluations from a societal perspective
332 citations
TL;DR: The Health and Labor Questionnaire (HLQ), which consists of four modules, is developed to collect data on absence from work, reduced productivity, unpaid labor production, and labor-related problems.
Abstract: A health care program may influence both costs and health effects. We developed the Health and Labor Questionnaire (HLQ), which consists of four modules, to collect data on absence from work, reduced productivity, unpaid labor production, and labor-related problems. We applied the HLQ in several studies, and the results are encouraging.
303 citations