Kosten-Nutzen-Bewertung - Leo Schütze Gmbh

gpk SONDERAUSGABE GESELLSCHAFTSPOLITISCHE KOMMENTARE Nr. 3/08 – November 2008 – Seite 16
Status quo and trends within the field
of quality adjusted life years
Von Prof. John E. Brazier
John E. Brazier, PhD (Sheffield), MSc (York), BA (Exeter), Professor of Health Economics in the School of Health
and Related Research at the University of Sheffield. He has been a member of a number of commissioning Boards,
including HTA, Trent Health and the MRC HSR Fellowship Panel. He was a member of the National Institute for
Clinical Excellence (NICE) Technology Appraisal Committee from 2000–2004.
Mean discounted utility
Status quo and trends within the
field of quality adjusted life years
John Brazier
Professor of Health Economics
Health Economics and Decision Science
School of Health and Related Research
University of Sheffield
Presentation for the Symposium on Cost-effectiveness
June 17 th 2008, Kaiserin-Friedrich-Stiftung, Berlin, Germany.
Measure of benefit
A new intervention:
• May be less effective and more costly…×
• More effective and less costly….. v
• More effective and more costly….?
• Plus less effective and less costly….?
0.45
0.4
0.35
0.3
0.25
0.2
0.15
0.1
0.05
0
? For resource allocation decisions in health care we
need a measure of benefit that allows comparisons to be
made across treatments and patient groups
Calculating QALY gain of PDT
on Macular Degeneration
0 - 3
3 - 6
6 - 9
9 - 12
12 - 15
15 - 18
18 - 21
21 - 24
24 - 27
27 - 30
31 - 33
33 - 36
36 - 39
39 - 42
42 - 45
45 - 48
48 - 51
51 - 54
54 - 57
57 - 60
60 - 63
63 - 66
66 - 69
69 - 72
72 - 75
75 - 78
78 - 81
81 - 84
84 - 87
87 - 90
90 - 93
93 - 96
96 - 99
99 - 102
102 - 105
105 - 108
108 - 111
111 - 114
114 - 117
117 -
Time in months
Verteporfin
Placebo
The problem
A finite limit to resources
Plus
demands/needs exceed current (or future)
resources
implies the necessity for choice
How should these choices be made?
Calculating QALY gain of PDT
Quality Adjusted Life Years
The Quality Adjusted Life Year (QALY) combines
quality of life and length of life into the single
measure of benefit of a quality adjusted survival
• The ‘Q’ (or utility) is a value assigned to each
health state from zero to one, where zero is for
state equivalent to death and one for full health
Trading off health and life
health
(full health) 1
(death) 0
10
time
Cost effectiveness
New interventions are assessed by NICE and
other agencies around the world in terms of:
• Clinical effectiveness
Assessed using systematic reviews of (largely)
RCT evidence for a range of clinical outcomes –
that increasingly includes quality of life
• Cost-effectiveness
Assessed in terms of the incremental (or extra)
cost per quality adjusted life years (QALYs) over
and above the existing treatment
health
(full health) 1
(death) 0
Quality-adjusted life years
Q
Source: Drummond et al, 1997
The time trade-off
T
10
Q×10 = 1×T
Q = T/10
If T = 6, then Q= 0.6,
and both options
provide 6 QALYs.
time
QALYs = total area