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    Cost Effectiveness Analysis with the RIVM Chronic Disease Model

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    Authors
    van Baal PHM
    Feenstra TL
    Hoogeveen RT
    de Wit GA
    Series/Report no.
    RIVM rapport 260706002
    Type
    Report
    Language
    en
    
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    Title
    Cost Effectiveness Analysis with the RIVM Chronic Disease Model
    Translated Title
    Kosten effectiviteits analyse met het RIVM Chronische Ziekten Model
    Publiekssamenvatting
    De medische kosten van alle ziekten die kunnen optreden in gewonnen levensjaren dienen te worden meegenomen in kosten effectiviteit analyses als ook de effecten van de medische zorg voor alle ziekten in gewonnen levensjaren worden meegenomen. In kosten effectiviteit analyses van primaire preventie worden vaak alleen de medische kosten van direct gerelateerde ziekten meegenomen. Bij kosten effectiviteit analyses van stoppen met roken interventies worden bijvoorbeeld wel de besparingen dankzij de vermeden kosten van longkanker meegenomen maar niet de medische kosten van een heupfractuur die iemand kan oplopen in zijn extra levensjaren. Dit is niet consistent als de winst in levensjaren dankzij de behandeling van de heupfractuur wel wordt meegenomen in de kosten effectiviteit analyse. Een van de toepassingen van het RIVM Chronische Ziekten Model (CZM) is het schatten van de kosten effectiviteit van interventies gericht op het verbeteren van de volksgezondheid in Nederland. De centrale vraagstelling van dit rapport is hoe we in kosten effectiviteit analyses met het CZM omgaan met de medische kosten en gezondheidseffecten van ziekten die zijn opgelopen in extra levensjaren. Met het CZM is het mogelijk om de medische kosten in gewonnen levensjaren in kosten effectiviteit analyses mee te nemen. Op basis van inzichten uit de recente economische literatuur concluderen wij dat de medische kosten van alle ziekten die kunnen optreden in extra levensjaren dienen te worden meegenomen als de effecten van de medische zorg in gewonnen levensjaren niet zijn te scheiden van de effecten van de interventie.

    Support of decision makers in health care priority setting is one of the objectives of cost effectiveness analysis. Cost effectiveness analysis presents the costs and effects of an intervention compared to an alternative in cost effectiveness ratios. The denominator of the ratio measures the health gain from the intervention and the numerator measures the costs of obtaining that health gain. The objective was to develop a methodology to be used with economic evaluations conducted with the RIVM Chronic Disease Model (CDM). Using the CDM to compute health effects and costs ensures that the same model is used for all different economic evaluations, which improves their comparability. The current report describes how cost effectiveness ratios are computed with the CDM. Special attention is paid to the selection and estimation of the costs and effects to be included during years of life gained. A cost effectiveness module was written to be attached to the RIVM Chronic Disease Model (CDM). To decide what costs and effects to include, a distinction was made between diseases causally related and diseases indirectly related to the intervention. Given this distinction the approach from Nyman (Health Economics 2004) was followed: all costs that directly produce the utility measured in the denominator have to be included in the numerator of the cost effectiveness ratio. To estimate the impact of indirectly related diseases on quality of life we use data from the Dutch Burden of Disease study. Data from the Costs of Illness study in the Netherlands were used to estimate the impact of an intervention on total health care costs. We argue that for comparison of different interventions with the RIVM CDM, one should include the costs and effects of both causally related and indirectly related diseases, since it seems impossible to isolate the precise effects of an intervention.
    Publisher
    Rijksinstituut voor Volksgezondheid en Milieu RIVM
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    RIVM
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