PRM11 Learning Effect in Economic Evaluations of Health Care Interventions

S. Chang, D. Sungher, A. Diamantopoulos
2011 Value in Health  
OBJECTIVES: To validate an alternative weighting algorithm of the Charlson Comorbidity Index (CCI) for the prediction of health care expenditures and utilization in previously hospitalized patients. METHODS: Data from the Medical Expenditure Panel Survey (MEPS) Panel 12 (2007)(2008) were retrieved for this retrospective cohort study. Two CCI scores were calculated for patients who were hospitalized in 2007: one based on the original weights (Charlson-CCI) and the other based on the weights
more » ... ed by Quan et al. (Quan-CCI) [both were developed to predict mortality]. Adjusted R2 from linear regression models were used to estimate log-transformed healthcare expenditures (COST) in 2008. Odds ratios and c statistics from logistic regression models were used to compare the predictive power of the risk of hospitalizations (Ն 1 admission), risk of emergency department visits (Ն 1 visit), and high expenditures (Ն 90th percentile of COST) in 2008. RESULTS: Seven hundred patients who had been previously hospitalized were included in the study. The mean (SD) age was 52.5 (15.3) years, and 65% were female. In the linear regressions, the Charlson-CCI explained more variance in COST than the Quan-CCI (adjusted R2 ϭ 20.7% vs. 19.9%), adjusting for age and sex. The Charlson-CCI was a better predictor of the risk of emergency department visits (cϭ0.600) than the Quan-CCI (cϭ0.571). Compared with the Quan-CCI, the Charlson-CCI showed better discriminatory power for the prediction of high-expenditure individuals (cϭ0.770 vs. 0.743) and the risk of hospitalizations (cϭ0.589 vs. 0.581). The Quan-CCI did not significantly predict high-expenditure individuals (ORϭ1.15; 95% CIϭ0.99-1.33) or the risk of hospitalizations (ORϭ1.14; 95% CIϭ0.99-1.30). CONCLUSIONS: In a group of previously hospitalized patients, the original CCI exhibited better discrimination for the prediction of healthcare expenditures, hospitalizations, and emergency department visits. The weights updated by Quan et al. were developed to predict mortality and may have limited utility in predicting health care utilization. OBJECTIVES: The Mutuelle Générale des Fonctionnaires et Agents de l'État de Côte d'Ivoire (MUGEFCI) is a health mutual providing coverage services for its enrolees (medical consultations, lab tests, medication expenses). This organization aims at improving its current drug reimbursement process because of budgetary constraints. This study, therefore, aims at evaluating the feasibility of developing a new formulary for the MUGEFCI in Côte d'Ivoire, by implementing a formularylisting framework specifically designed for under researched settings. METHODS: The application of this framework, based on Multi-criteria Decision Analysis (MCDA), consisted in four steps. First of all, we identified and weighted relevant formulary listing criteria with their levels of variation. Then, we determined a set of priority diagnostic/treatments to be assessed. Furthermore, scores were assigned to these treatments according to their performance on the formulary listing criteria levels. Last, we constructed a composite league table to rank the set of treatments by priority order of reimbursement. A budget impact analysis was also conducted to appraise the economic implications of the new composite drugs league table. RESULTS: Policymakers in Côte d'Ivoire consider targeting cost-effectiveness and severity of diseases as the most significant criteria for priority reimbursement of drugs. This translates into a general preference for antimalarial, treatments for asthma and antibiotics for urinary infection. Moreover, the results of the BIA suggest that the new priority list of reimbursable drugs will be affordable when the real economic impact of drugs per patient is under 66 US dollars. Over this threshold, the MUGEFCI will have to select the reimbursable drugs according to their rank in the priority list along with their respective budget impact per patient (cost per patient). CONCLUSIONS: It is feasible to use MCDA to establish a formulary for low-income countries. The application of this method is a step forward to transparency in policymaking. 1 Agenas, Agenzia nazionale per i servizi sanitari regionali,
doi:10.1016/j.jval.2011.08.1042 fatcat:fptlyerus5egbpohewtsx2iozi