make nutrition services count: cost-effectiveness research & outcomes research

Make Nutrition Services Count:Cost-Effectiveness Research

& Outcomes Research

Outcomes Researchand Cost Effectiveness

Setting value to what we do

ADA’s Commitment to Cost Effectiveness

National Academy of Sciences Report Dietetics Outcomes Research Steering

Committee Health Services Research Committee Quality Management Committee Lewin Study

Define outcomes / CE terms

Methods of evaluation in health care

Distinguish the features of cost-effectiveness research

Identify barriers/ limitations and resources in conducting CE studies

Identify activities that may promote CE studies

Objectives:

OutcomeOutcomeThe result of the performance (or

nonperformance) of a function or process(es). JCAHO 1996

Outcome IndicatorOutcome IndicatorMeasures what happens (or does not

happen) to a patient after something is done (or not done) to the patient. NLHI

Terms

Cost Benefit AnalysisCost Benefit AnalysisAn analytic tool for estimating the net

social benefit of a program or intervention as the incremental benefit of the program less the incremental cost, with all benefits and costs measured in dollars.

Cost Effectiveness in Health and Medicine. Gold, Martha, et al 1996 University Press

Terms

Cost EffectivenessCost EffectivenessAn analytic tool in which costs and effects

of a program and at least one alternative are calculated and presented in a ratio of incremental costs to incremental effects. Effects are health outcomes such as cases of a disease presented, years of life gained or quality adjusted life years rather than monetary measures as in cost benefit analysis.Cost Effectiveness in Health and Medicine. Gold, Martha, et al 1996 University Press

Terms

QALYQALY“Quality-adjusted life year”

Terms

Terms

DFLEDFLE“Disability-free life expectancy”

Life expectancy free of class I (or worse) disability

Disability classes based on person-trade off method

Terms

DALEDALE“Disability-adjusted life expectancy”

HLHLxx = L = Lxx ( 1 - ( 1 - PPixix DDixix ))

Where:

HLx =the number of years of healthy life lived at age

x

Lx = the number of years of life lived at age x from a

life table

Pix =the prevalence of disabling sequelae j at age x

Dix =the disability severity weight for disabling

sequelae j at age x






Objectives:

Methods of Evaluation in Health Care

Measurements

A. In natural units on a undimensional scaleB. In units of a cardinal utility function, which is

used to transform the multidimensional concept of ‘health’ into a scalar index’

C. In monetary units

Zweifel P: Health Economics, 1997


Natural Units:

A clinical parameter - blood pressure Length of life in years

This method only makes sense if the alternatives to be compared have one specific effect and not side effects.



Natural Units:

A clinical parameter - blood pressure– compare two different drugs - no side effects– compare two different diet interventions - no

side effects

OR– two safety measures designed to avoid fatal

traffic crashes


Methods of Evaluation in Health Care: CEA

Method of evaluation would be cost-effectiveness analysis (CEA). Only for mutually exclusive projects.

t1CEA = costs in units of money

benefits in mmHg

and

t2CEA = costs in units of money

benefits in additional life years



Limitations of CEA

Its application implies that who obtains the additional life years is of not relevance

It does not lend itself to the evaluation of projects with several different (positive) effects.

Provides a rank order of preference among mutually exclusive projects, it does not answer the question which of the projects should be realized and which should not



Measurements

A. In natural units on a undimensional scaleB. In units of a cardinal utility function, which is

used to transform the multidimensional concept of ‘health’ into a scalar index’

C. In monetary units


Methods of Evaluation in Health Care: CUA

Method of evaluation that takes account of the multidimensionality of the concept ‘health’ by trying to encompass all effects of an intervention - prolonging life and changing health status.

tCUA = costs in units of money

benefits in QALYsThe index value may be interpreted as ‘QALYs’ gained.

Again, only for mutually exlusive projects.

Unlike CEA, suitable for comparing medical interventions of heterogeneous kind and purpose


Methods of Evaluation in Health Care: CBA


Monetary equivalents are assigned to prolongations of life and change of health status.

tCBA = costs in units of money

benefits in units of money

Methods of Evaluation in Health Care:


Unlike cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis circumvent the problem of monetary evaluation of life and health. However, they provide only a relative evaluation of mutually exclusive projects, while CBA permits evaluation of each

project on its own.

Objectives






Outcomes ResearchOutcomes Research– Process

Identify the outcome (what we effect) Set a clear definition of the outcome

– Implementation Measure Analyze Evaluate

Features of Cost Effectiveness

Examples of research on Examples of research on indictors:indictors:

AntecedentsEpidemiological term similar to

exposure

_______________________________________


Examples of outcomes Examples of outcomes research:research:

_______________________________________


What it is -

What is Cost-Effectiveness?

What it is not-

What it is -“a method for evaluating the health outcomes and resource costs of health interventions”

Russell, et al., JAMA 1996;276:1172



Interventions– Nutrition Support– MNT Protocols– Presence of the RD on

the health care team, in the public health jurisdiction, etc.


Outcomes in CEA– Traditional

Medical Outcomes

– Resource Costs

– Expanded definitionPatient centered outcomes

Quality of life; Client satisfaction


Cost-Savings

Cheaper bang

Cost-Benefit Analysis

All benefits cost in dollars

?? Putting dollar value on life years

What it is not -

What it is -

Hoch JS: Health Econ. 11: 415–430 (2002), Published online 31 January 2002 in Wiley InterScience (www.interscience.wiley.com).

Objectives






Barriers and Limitations

ExpectationsTrainingSupportOutcomes difficult to measureTime of follow-upCo-Morbidity'sResearch training

Strengths

Documentation of worthBenchmark for change

Objectives






Cost-Effectiveness

make nutrition services count: cost-effectiveness research & outcomes research

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