Kosteneffectiviteit: een kans voor effectieve behandelingen

1. Kosteneffectiviteit: een kans voor effectieve behandelingen • Prof. dr. Jan van Busschbach • Viersprong Institute for studies on Personality Disorders • VISPD • Erasmus MC • Department of Psychiatry • J.vanbusschbach@erasmusmc.nl • ForCA, 25 november 2013, Utrecht 1

2. Economics Costs and effects Choice Perspective

3. 1. cost and effects

4. Costs of crime prevention Moolenaar et al. (2011)

5. Effects • Less crime • More school attendance • Better quality of life • Victim • Criminal person

6. 2. choice Costs A Intervention A Outcomes A Difference Choice Intervention B Outcomes B Costs B

7. ‘Full’ economic evaluation Drummond et al. (2005)

8. 3. Perspectives • Insurance • Payers perspective • Government • Local government • Societal • Tax payers

9. Societal perspective • All costs, all effects • No matter who gets them • Life time costs • Not only for duration of intervention

10. An example: Tax payers perspective Aos et al. (2004) 10

11. What they did….

12. High costs victims The public costs and benefits per participant of the High/Scope Perry Preschool Study (Schweinhart, 2003)

13. Variance in price of crime to victims

14. Relate costs to effects in natural units • Cost benefit • Effects are expressed as costs • Cost effectiveness • Effects: ‘natural units' relevant to the intervention • Examples • Cost per avoided crime • Cost per school return • Cost per prevented out-of-home placement • Problem: • How can we make cost-effectiveness results comparable to other interventions for which budgets should be allocated?

15. Health Economics • Comparing different allocations • Should we spent our money on • Wheel chairs • Screening for cancer • Comparing costs • Comparing outcome • Outcomes must be comparable • Make a generic outcome measure

16. Outcomes in health economics • Specific outcome are incompatible • Allow only for comparisons within the specific field • Clinical successes: successful operation, total cure • Clinical failures: “events” • “Hart failure” versus “second psychosis” • Generic outcome are compatible • Allow for comparisons between fields • Life years • Quality of life • Most generic outcome • Quality adjusted life year (QALY)

17. 1.00 X 0.00 Quality Adjusted Life Years (QALY) • Example • Blindness • Quality of life value is 0.5 • Life span = 80 years • 0.5 x 80 = 40 QALYs 0.5 x 80 = 40 QALYs 80 40 Life years 17 17

18. Area under the curve

19. 7000 Citations in PubMed 19

20. Criminal activity free year: CAFY

21. Societal perspective: Include a wide range of costs

22. C - dead B – not criminal Life time cost and effects: modelling 1 1 minus effect of intervention Costs criminal Costs dead Natural mortality rate A - criminal Probability of relapse Effect of intervention Natural mortality rate 1 minus probability of relapse Costs not criminal + Costsintervention

23. Costsandeffects I Petrou & Gray (2011)

24. Choice and uncertainty 100% < € 20.000 90% < € 0

25. Few cost-effectiveness studies • Only a few follow the guidelines • Non in The Netherlands • Welsh & Farrington, 2000 • A review of the literature revealed only seven [7] published studies that have presented information on monetary costs and benefits. • McDougall et al., 2003 • A systematic review of the literature revealed only nine [9] published studies that fit the criteria of the review. • Swaray et al., 2005 • “10 studies fit the criteria of the review” • Soeteman & Busschbach, 2008 • 12 studies

27. Markov model

28. Choice: CEAC

29. Conclusions • Not much work has yet been done in The Netherlands • Cost of crime is complex to estimate • What categories should be included? • How should you estimate these costs? • Cost effectiveness might be a new approach • Cost per avoided crime • Cost per CAFY

30. Types of full economic evalutation Drummond et al. (2005)