Question

CAR com a treenmat ICER=CB - CA EAs gincul Effecweiss Incierated EB-EA Case 1 The health authorities are considering the treatment alternatives for three types of diseases: hearth disease, cancer and infectious disease. Each year, there are 10,000 new cases of heart disease, 10.000 new cases of cancer and 5,000 new cases of infectious disease. For each diagnosis, there are a number of mutually independent treatment alternatives (including no treatment) as shown in the following table. Cost per treatment QALYs gained Incremental incremental ICER DALS Heart Disease 100 300 400 NER (6/c 507 37.5 300 +8=37.5 DOSSONO NEREN 500a143 600 CANCER 200 Nee 300425 500 600 M Infectious Disease 100 10022-50 350 650 a) Identify all dominant treatment alternatives. Explain why cach is dominant b) Calculate the incremental cost, incremental QALYs and ICER for all economically rational strategies ICELA. Costine QALS c) Why are these considered economically rational? d) Using separate graphs for heart disease, cancer and infectious disease, show the alternative treatment options. Label the dominant options and show the economically feasible alternatives. (Place QALYs on the vertical axis and cost per treatment on the horizontal axis. e) The local health district has asked your opinion on the "best" strategy from a public health perspective (disease covered treatment strategy). What do you tell them? How much will it cost?

Answer 1

We will use this table with the relevant calculations to answer the questions.

Treatment	Cost per treatment	Qaly gained	Incremental cost	Incremental Qaly	ICER (=incremental cost /incremental Qaly)
Heart disease
A	0	0	0	0
B	100	2	100	2	50.00
C	300	8	200	6	33.33
D	400	8	100	0	nm
E	600	12	200	4	50.00
F	800	15	200	3	66.67
Cancer
G	0	0	0	0
H	200	8	200	8	25.00
I	400	10	200	2	100.00
J	500	12	100	2	50.00
K	600	9	100	-3	-33.33
L	700	14	100	5	20.00
M	800	15	100	1	100.00
Infectious disease
N	0	0	0	0
O	100	2	100	2	50.00
P	350	4	250	2	125.00
R	650	6	300	2	150.00

a) A dominant treatment alternative is the one with the lowest (but positive) ICER. These are the following:

Heart disease: treatment C

Cancer: treatment L

Infectious disease: treatment O

b) Pls see the table above. Treatment K is not economically rational since it has negative incremental Qaly

c) These are economically rational since they provide incremental Qaly (positive) for incremental cost

d) Pls see graphs below

Heart disease

0 100 200 300 400 500 600 700 800 900

Cancer

0 100 200 300 400 500 600 700 800 900

Infectious disease

0 100 200 300 400 500 600 700

e) We can calculate the cost as follows, using the dominant treatment options as per question a

	No. of patients	Chosen treatment	Cost per treatment	Total cost
Heart disease	10000	C	300	3000000
Cancer	10000	L	700	7000000
Infectious disease	5000	O	100	500000
Total				10500000