Case study: Deciding what is effective from different perspectives

The aim of this case study is to illustrate the sometimes competing demands of effectiveness, efficiency and equity. In particular, it should help you to:

Explain what is meant by key terms such as LYG, QALY and ICER

Use these terms and the information they represent in a decision-making scenario Compare and contrast the demands of effectiveness from different perspectives

Scenario

You are a member of an area prescribing committee (APC) which is reviewing the treatment options for a cancer which is universally rapidly fatal (usually within months) if not treated. For the purposes of this cases study, please assume the following:

There is good evidence supporting the effectiveness of three medicines (A, B and C) in improving health outcomes.

The treatments are mutually exclusive: there is no evidence that patients are better off switching from one to another.

Effectiveness does not depend on patient or disease characteristics.

All costs fall within the first year of treatment.

Costs vary only according to the drug selected, since staff time, etc. are fixed and are the same requirements for each treatment.

The annual budget available for commissioning treatment is US$500,000. The incidence of this cancer in the area covered by your APC is 1,000 new cases each year.

The health economic data are summarized below:

Treatment	Life-Year Gained	Health Utility Index (in each year)	Cost (per patient)
A (current practice)	0.3	0.8	$500
B	0.6	0.6	$1,000
C	0.5	0.5	$800

Question 1: Given the available budget of $500,000 per year, how many people could be treated with each option? Please show your calculation and explain briefly about why the current practice is Treatment A. (20%)

Question 2: Measuring the cost-effectiveness by the incremental cost-effectiveness ratio (ICER), compared with the current practice, which treatment (B or C) is more cost-effective for a hospital use? Please show your calculation and explain briefly. (20%)

Question 3: From a patient perspective, which treatment is the most effective by considering the quality of life? Please show your calculation and explain briefly. (20%)

Question 4: From a society perspective, which treatment generates the greatest health gains given the funds available? Please show your calculation and explain briefly. (20%)

Question 5: Which treatment would you recommend to the area prescribing committee (APC): A, B or C? Please discuss your choice from perspectives of equity, efficiency and effectiveness. (20%)

Limit your answer within 2 pages in a MS Word file. No cover page is required.