Pub Date : 2014-11-01Epub Date: 2014-11-04DOI: 10.1515/fhep-2014-0013
Julie Zissimopoulos, Eileen Crimmins, Patricia St Clair
Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.
{"title":"The Value of Delaying Alzheimer's Disease Onset.","authors":"Julie Zissimopoulos, Eileen Crimmins, Patricia St Clair","doi":"10.1515/fhep-2014-0013","DOIUrl":"https://doi.org/10.1515/fhep-2014-0013","url":null,"abstract":"<p><p>Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"18 1","pages":"25-39"},"PeriodicalIF":0.0,"publicationDate":"2014-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2014-0013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34361480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Bans on retail tobacco displays, of the type proposed by New York’s Mayor Bloomberg in March 2013, have been operative in several economies since 2001. Despite an enormous number of studies in public health journals using attitudinal data, we can find no econometric event studies of the type normally used in Economics. This paper attempts to fill that gap by using data from 13 cross sections of the annual Canadian Tobacco Use Monitoring Surveys. These data afford an ideal opportunity to study events of this type given that each of Canada’s 10 provinces implemented display bans at various points between 2003 and 2009. Accordingly, we use difference-in-difference methods to study three behaviors following the introduction of bans: participation in smoking, the intensity of smoking and quit intentions. A critical element of the study concerns the treatment of contraband tobacco. Our estimates provide very little support for the hypothesis that behaviors changed following the bans.
{"title":"Retail Tobacco Display Bans","authors":"I. Irvine, V. Nguyen","doi":"10.1515/fhep-2013-0019","DOIUrl":"https://doi.org/10.1515/fhep-2013-0019","url":null,"abstract":"Abstract Bans on retail tobacco displays, of the type proposed by New York’s Mayor Bloomberg in March 2013, have been operative in several economies since 2001. Despite an enormous number of studies in public health journals using attitudinal data, we can find no econometric event studies of the type normally used in Economics. This paper attempts to fill that gap by using data from 13 cross sections of the annual Canadian Tobacco Use Monitoring Surveys. These data afford an ideal opportunity to study events of this type given that each of Canada’s 10 provinces implemented display bans at various points between 2003 and 2009. Accordingly, we use difference-in-difference methods to study three behaviors following the introduction of bans: participation in smoking, the intensity of smoking and quit intentions. A critical element of the study concerns the treatment of contraband tobacco. Our estimates provide very little support for the hypothesis that behaviors changed following the bans.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"34 1","pages":"169 - 195"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82740935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer
Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.
我们分析了口服营养补充剂(ONS)使用对住院医保患者(≥65岁)30天再入院率、住院时间(LOS)和发作费用的影响，以及诊断为急性心肌梗死(AMI)、充血性心力衰竭(CHF)或肺炎(PNA)患者亚群的影响。倾向得分匹配和工具变量用于分析来自Premier Research Database(2000-2010)的国家统计局和非国家统计局事件。使用ONS与AMI患者30天再入院概率降低12.0%和CHF患者降低10.1%相关。AMI患者的LOS降低10.9%，CHF患者的LOS降低14.2%，PNA患者的LOS降低8.5%与ONS相关，AMI、CHF和PNA患者的发作成本分别降低5.1%、7.8%和10.6%。对任意诊断人群的LOS和发作费用的影响最大，分别下降了16.0%和15.8%。在65岁以上的住院医疗保险患者中使用ONS与改善预后和降低医疗成本相关，因此与寻求廉价、循证方法以满足《平价医疗法案》质量目标的提供者相关。
{"title":"Can Oral Nutritional Supplements Improve Medicare Patient Outcomes in the Hospital?","authors":"D. Lakdawalla, J. Snider, D. Perlroth, C. LaVallee, M. Linthicum, T. Philipson, J. Partridge, P. Wischmeyer","doi":"10.1515/fhep-2014-0011","DOIUrl":"https://doi.org/10.1515/fhep-2014-0011","url":null,"abstract":"Abstract We analyzed the effect of oral nutritional supplement (ONS) use on 30-day readmission rates, length of stay (LOS), and episode costs in hospitalized Medicare patients (≥65), and subsets of patients diagnosed with acute myocardial infarction (AMI), congestive heart failure (CHF) or pneumonia (PNA). Propensity-score matching and instrumental variables were used to analyze ONS and non-ONS episodes from the Premier Research Database (2000–2010). ONS use was associated with reductions in probability of 30-day readmission by 12.0% in AMI and 10.1% in CHF. LOS decreases of 10.9% in AMI, 14.2% in CHF, and 8.5% in PNA were associated with ONS, as were decreases in episode costs in AMI, CHF and PNA of 5.1%, 7.8% and 10.6%, respectively. The effect on LOS and episode cost was greatest for the Any Diagnosis population, with decreases of 16.0% and 15.8%, respectively. ONS use in hospitalized Medicare patients ≥65 is associated with improved outcomes and decreased healthcare costs, and is therefore relevant to providers seeking an inexpensive, evidence-based approach for meeting Affordable Care Act quality targets.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"41 1","pages":"131 - 151"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79479196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.
{"title":"The Effects of Smoking Cessation on Weight Gain: New Evidence Using Workplace Smoking Bans","authors":"Jason M. Fletcher","doi":"10.1515/fhep-2013-0004","DOIUrl":"https://doi.org/10.1515/fhep-2013-0004","url":null,"abstract":"Abstract Both tobacco use and obesity are among the most important and costly health challenges faced in developed countries. Unfortunately, they may be inversely linked. While policy interventions that have placed limits on tobacco use have increased substantially over time, one unintended consequence may be to increase obesity rates. Issues of selection and unobserved heterogeneity make it difficult to empirically assess the relationship between the two health outcomes. Additionally, there may be heterogeneous policy effects by cessation cause – smoking bans or medical treatments or tobacco prices. This paper focuses on the effects of a rapidly expanding policy by using within-individual differences in exposure to workplace smoking bans to estimate the impact of smoking cessation on weight gain using a large study of over 5000 White and Black respondents followed since 1986. Findings suggest that individuals affected by the smoking bans gained more weight in the short-term than suggested by OLS estimates.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"28 1","pages":"105 - 129"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80018539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Seabury, D. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman
Abstract Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.
{"title":"Patient Outcomes and Cost Effects of Medicaid Formulary Restrictions on Antidepressants","authors":"S. Seabury, D. Lakdawalla, D. Walter, J. Hayes, T. Gustafson, A. Shrestha, D. Goldman","doi":"10.1515/fhep-2014-0016","DOIUrl":"https://doi.org/10.1515/fhep-2014-0016","url":null,"abstract":"Abstract Many state Medicaid programs have implemented policies designed to reduce spending on prescription drugs by restricting access to branded products. For patients with major depressive disorder, formulary restrictions could severely limit access to antidepressant therapies and disrupt care. We linked data on patient outcomes and spending from 24 state Medicaid programs to information on formulary restrictions from 2001 to 2008. Outcomes included frequency of MDD-related hospitalizations and ER visits per patient and total healthcare spending. We estimated the effect of the policies on patient outcomes and spending using a difference-and-difference approach. We found that restricting access to antidepressants increased the probability of an MDD-related hospitalization by 1.7 percentage points (16.6%). Furthermore, we found no evidence that these restrictions resulted in any net savings for Medicaid.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"17 1","pages":"153 - 168"},"PeriodicalIF":0.0,"publicationDate":"2014-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89589914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10–20 years, income effects will have little effect on cost growth in Medicare.
{"title":"A Note on Income Effects and Health Care Cost Growth in Medicare","authors":"T. Mcguire","doi":"10.1515/fhep-2013-0001","DOIUrl":"https://doi.org/10.1515/fhep-2013-0001","url":null,"abstract":"Abstract This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10–20 years, income effects will have little effect on cost growth in Medicare.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"12 1","pages":"1 - 12"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85873619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% percent subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10-20 years, income effects will have little effect on cost growth in Medicare.
{"title":"A Note on Income Effects and Health Care Cost Growth in Medicare.","authors":"Thomas G McGuire","doi":"10.1515/fhep-2013-0","DOIUrl":"https://doi.org/10.1515/fhep-2013-0","url":null,"abstract":"<p><p>This paper sets out a model of technical change and health care cost growth for a representative Medicare beneficiary facing a budget constraint. Derivation of an explicit expression for health care cost growth shows how technological change and preferences, including income effects, affect cost growth. The analysis highlights the role of the 76% percent subsidy from current taxpayers to Medicare beneficiaries for purchase of health insurance. This subsidy insulates beneficiaries from the income effects of cost growth by shifting the costs and income effects to taxpayers. Simulations show that over the next 10-20 years, income effects will have little effect on cost growth in Medicare.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"17 1","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2014-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548929/pdf/nihms-713000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34026350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Barriers and delays to medical device innovation are often solely attributable to the regulatory environment instead of both the current state of innovation practices and product development processes in the industry. Increasing the pace of innovation while reducing costs requires the creation of a new approach that fits both established medical device corporations as well as entrepreneurial start-ups. In this commentary we advance the concept of innovation platforms to facilitate ideation in the medical device space. Such platforms could also allow the full health benefits from individual medical devices to be reaped, by overcoming interoperability concerns through simulation and credentialing. Given the dramatic benefits of medical device success, such non-traditional business models for development may be potential solutions for industry, users and regulators.
{"title":"The Crowd, the Cloud and Improving the Future of Medical Device Innovation","authors":"Marco D. Huesch, R. Szczerba","doi":"10.1515/fhep-2012-0023","DOIUrl":"https://doi.org/10.1515/fhep-2012-0023","url":null,"abstract":"Abstract Barriers and delays to medical device innovation are often solely attributable to the regulatory environment instead of both the current state of innovation practices and product development processes in the industry. Increasing the pace of innovation while reducing costs requires the creation of a new approach that fits both established medical device corporations as well as entrepreneurial start-ups. In this commentary we advance the concept of innovation platforms to facilitate ideation in the medical device space. Such platforms could also allow the full health benefits from individual medical devices to be reaped, by overcoming interoperability concerns through simulation and credentialing. Given the dramatic benefits of medical device success, such non-traditional business models for development may be potential solutions for industry, users and regulators.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"75 1","pages":"13 - 20"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89012401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin F Erickson, Wolfgang C Winkelmayer, Glenn M Chertow, Jay Bhattacharya
The relation between the quantity of many healthcare services delivered and health outcomes is uncertain. In January 2004, the Centers for Medicare and Medicaid Services introduced a tiered fee-for-service system for patients on hemodialysis, creating an incentive for providers to see patients more frequently. We analyzed the effect of this change on patient mortality, transplant wait-listing, and costs. While mortality rates for Medicare beneficiaries on hemodialysis declined after reimbursement reform, mortality declined more - or was no different - among patients whose providers were not affected by the economic incentive. Similarly, improved placement of patients on the kidney transplant waitlist was no different among patients whose providers were not affected by the economic incentive; payments for dialysis visits increased 13.7% in the year following reform. The payment system designed to increase provider visits to hemodialysis patients increased Medicare costs with no evidence of a benefit on survival or kidney transplant listing.
{"title":"Medicare Reimbursement Reform for Provider Visits and Health Outcomes in Patients on Hemodialysis.","authors":"Kevin F Erickson, Wolfgang C Winkelmayer, Glenn M Chertow, Jay Bhattacharya","doi":"10.1515/fhep-2012-0018","DOIUrl":"https://doi.org/10.1515/fhep-2012-0018","url":null,"abstract":"<p><p>The relation between the quantity of many healthcare services delivered and health outcomes is uncertain. In January 2004, the Centers for Medicare and Medicaid Services introduced a tiered fee-for-service system for patients on hemodialysis, creating an incentive for providers to see patients more frequently. We analyzed the effect of this change on patient mortality, transplant wait-listing, and costs. While mortality rates for Medicare beneficiaries on hemodialysis declined after reimbursement reform, mortality declined more - or was no different - among patients whose providers were not affected by the economic incentive. Similarly, improved placement of patients on the kidney transplant waitlist was no different among patients whose providers were not affected by the economic incentive; payments for dialysis visits increased 13.7% in the year following reform. The payment system designed to increase provider visits to hemodialysis patients increased Medicare costs with no evidence of a benefit on survival or kidney transplant listing.</p>","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"17 1","pages":"53-77"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/fhep-2012-0018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34293533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Warren Stevens, T. Philipson, Yanyu Wu, Connie Chen, D. Lakdawalla
Abstract Payers increasingly require evidence of a statistically significant difference in overall survival (OS) for reimbursement of new cancer therapies. At the same time, it becomes increasingly costly to design clinical trials that measure OS endpoints instead of progression-free survival (PFS) endpoints. While PFS is often an imperfect proxy for OS effects, it is also faster and cheaper to measure accurately. This study develops a general cost-benefit framework that quantifies the competing trade-offs of the use of PFS versus that of OS in oncology reimbursement. We then apply this general framework to the illustrative case of metastatic renal cell carcinoma (mRCC). In the particular case of mRCC, the framework demonstrates that the net benefit to society from basing reimbursement decisions on PFS endpoints could be between $271 and $1271 million in the United States, or between €171 and €1128 million in Europe. In longevity terms, waiting for OS data in this case would result in a net loss of 3549–14,557 life-years among US patients, or 6785–27,993 life-years for European patients. While more stringent standards for medical evidence improve accuracy, they also impose countervailing costs on patients in terms of foregone health gains. These costs must be weighed against the benefits of greater accuracy. The magnitudes of the costs and benefits may vary across tumor types and need to be quantified systematically.
{"title":"A Cost-Benefit Analysis of Using Evidence of Effectiveness in Terms of Progression Free Survival in Making Reimbursement Decisions on New Cancer Therapies","authors":"Warren Stevens, T. Philipson, Yanyu Wu, Connie Chen, D. Lakdawalla","doi":"10.1515/fhep-2013-0025","DOIUrl":"https://doi.org/10.1515/fhep-2013-0025","url":null,"abstract":"Abstract Payers increasingly require evidence of a statistically significant difference in overall survival (OS) for reimbursement of new cancer therapies. At the same time, it becomes increasingly costly to design clinical trials that measure OS endpoints instead of progression-free survival (PFS) endpoints. While PFS is often an imperfect proxy for OS effects, it is also faster and cheaper to measure accurately. This study develops a general cost-benefit framework that quantifies the competing trade-offs of the use of PFS versus that of OS in oncology reimbursement. We then apply this general framework to the illustrative case of metastatic renal cell carcinoma (mRCC). In the particular case of mRCC, the framework demonstrates that the net benefit to society from basing reimbursement decisions on PFS endpoints could be between $271 and $1271 million in the United States, or between €171 and €1128 million in Europe. In longevity terms, waiting for OS data in this case would result in a net loss of 3549–14,557 life-years among US patients, or 6785–27,993 life-years for European patients. While more stringent standards for medical evidence improve accuracy, they also impose countervailing costs on patients in terms of foregone health gains. These costs must be weighed against the benefits of greater accuracy. The magnitudes of the costs and benefits may vary across tumor types and need to be quantified systematically.","PeriodicalId":38039,"journal":{"name":"Forum for Health Economics and Policy","volume":"4 1","pages":"21 - 52"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75709695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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