The following is a selection of current research projects in which the Health Economics-iMTA research group is involved. A short summary is provided for each project.
- Evidence synthesis
- ‘Estimating indirect medical costs and its associated uncertainty’
- Quality of life in expensive drugs: deriving preferences in absence of generic health state valuations
Updating parameters of decision-analytic cost-effectiveness models: a systematic comparison of methods.
After the introduction of a new drug, various trials are often conducted to compare the drug with other drugs. These trials often reach (slightly) different conclusions. This project is about bringing together these various sources of information. This process is called meta-analysis, or data synthesis. We will compare a number of frequently used meta-analysis methods.
A major problem in health care is that there is often no direct evidence, only indirect evidence: drug A is compared with drug B, and drug B is compared with drug C, but there is no direct evidence regarding drug A compared with drug C. There are also various methods involved here, which we will compare.
The study mainly looks at what the different methods of meta-analysis mean for weighing up the costs (e.g. higher price for the drug) and benefits (e.g. living longer) provided by the new drug compared to the old drug (i.e. the cost-effectiveness).
Hospitals are facing increasing numbers of COPD patients suffering bouts of acute shortness of breath. In the GO-AHEAD project, patients were therefore discharged after just three days in hospital. They then received four days of home care. In this sub-project, we explore the reasons why the parties concerned choose either hospital or home care.
Patients, carers and care providers completed a questionnaire. They were asked to choose between three treatments: standard hospitalisation or two combinations of shorter hospitalisation followed by home care. The characteristics of these treatments were always different: the frequency of home visits by the nurse, the co-payment, the burden on the carer, the number of different nurses, the risk of rehospitalisation and the nurse’s level of training.
What are the benefits?
We can see exactly which factors determine the preference for hospital care or home care. The results are useful for doctors, hospitals, insurers and other organisations that are involved in the decision-making about treatments.
What is the right balance between the costs and benefits of good treatment? This study compares two groups of patients with hay fever and house dust mite allergy. One group will continue their standard treatment of tablets, nose spray and/or ear drops. The other group receives, in addition, a highly diluted solution of their allergen. This treatment is known as immunotherapy. No one is given fake medicine. This approach makes it possible to study whether the drawbacks to immunotherapy outweigh the advantages.
The advantages are long-term decrease in allergic complaints, resulting in the patient needing less medication, feeling better at home and at work and not being off sick as often.
The drawbacks are the high cost of the treatment, the length of the treatment (monthly injections for 3-5 years) and potential side effects. Immunotherapy is therefore a good treatment, but it is certainly not ideal. That is why this study uses the responses to Internet questionnaires to explore whether immunotherapy is worth the money and the trouble involved.
For more information, please go to www.airforce-onderzoek.nl.
If someone lives longer thanks to preventive or curative treatment, it is very likely that this person will consume medical care in his or her additional years of life. Take John, for instance, who underwent a successful heart transplant when he was 60 years old. Thanks to the heart transplant, John will not die at 60, but at 75, and he will consume medical care during these 15 additional years. This medical care in the additional years is often referred to as ‘indirect medical costs’ in specialist literature.
A tool kit has been developed for including indirect medical costs in economic assessments in a standardised way. This tool kit is called PAID 1.0: Practical Application to Include future Disease costs. The goal of this project is to expand the methodology of PAID in order to quantify the uncertainty regarding the estimation of indirect medical costs. The result will be PAID 2.0.
Quality of life in expensive drugs: deriving preferences in absence of generic health state valuations
Drugs can have a positive or negative impact on a patient’s quality of life. In the Netherlands, drugs that provide a very significant improvement in quality of life are allowed to be more expensive than drugs that do not. Sometimes, however, no research at all has been conducted to obtain information about the patients’ quality of life. This makes it difficult to determine whether a drug is worth the money.
We used three methods – mapping, direct valuation and ranking – to determine the best way of replacing missing data on quality of life.
All three methods were found to work. The preferred method depends on the user’s goal. The mapping technique is preferable for use in analyses of drug cost-effectiveness. This technique is best suited for replacing the missing quality of life data.