Chapter 4, Problem 2QAP

(a)

To determine

The key screening strategies and the reason for them to be important than others.

Explanation of Solution

  $\begin{array}{cccccc}\text{Strategy}& \text{Cost}& \text{QALY}\text{Saved}& \text{Incremental}\text{Cost}& \text{Incremental}\text{QALY}& \text{Incremental}\text{CE}\text{Ratio}\\ \text{0}\text{.}\text{No}\text{screening}& 5000& 26.87& -& -& -\\ \text{1}\text{.}\text{Pap}\text{}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6825& 27.87& 1825& 1& 1825\\ \text{2}\text{.}\text{HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6950& 27.02& 125& -0.85& -147.05\\ \text{3}\text{.}\text{Pap}\text{}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7275& 27.04& 325& 0.02& 16250\\ \text{4}\text{.}\text{Pap+HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 7400& 27.04& 125& 0& 0\\ \text{5}\text{.}\text{HPV}\text{every}\text{2}\text{years}\text{to}\text{}\text{age}\text{75}& 7450& 27.04& 50& 0& 0\\ \text{6}\text{.}\text{Pap+HPV}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7925& 27.05& 475& 0.01& 47500\end{array}$

  $$

As per the table, option 1, 3 and 6 could be considered as dominant options. In option 1 it is true that there is an incremental cost. Nevertheless, its QALY value is positive. Hence it could be considered as dominant. Further, in option 3, a positive QALY has been derived with an incremental cost that is considerably low. In option 6, both the tests could be done. However, the incremental cost involved does not seem alarming. Its QALY value is also a positive figure.

Economics Concept Introduction

Introduction:

When selecting between various treatment options, it is important to look into various measures that make them dominant. In this case, the cost of the treatment as well as the QALY value has been looked into. QALY or Quality Adjusted Life Year is a weighted average measure that takes into account both the qualitative and quantitative aspects of the burden of a disease. This is helpful in determining the level of medical intervention needed.

(b)

To determine

The incremental cost values, incremental QALY values and incremental cost effective ratios for the treatment options that seem to be economically rationale and state why they are so.

Explanation of Solution

  $\begin{array}{cccccc}\text{Strategy}& \text{Cost}& \text{QALY}\text{Saved}& \text{Incremental}\text{Cost}& \text{Incremental}\text{QALY}& \text{Incremental}\text{CE}\text{Ratio}\\ \text{0}\text{.}\text{No}\text{screening}& 5000& 26.87& -& -& -\\ \text{1}\text{.}\text{Pap}\text{}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6825& 27.87& 1825& 1& 1825\\ \text{2}\text{.}\text{HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6950& 27.02& 125& -0.85& -147.05\\ \text{3}\text{.}\text{Pap}\text{}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7275& 27.04& 325& 0.02& 16250\\ \text{4}\text{.}\text{Pap+HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 7400& 27.04& 125& 0& 0\\ \text{5}\text{.}\text{HPV}\text{every}\text{2}\text{years}\text{to}\text{}\text{age}\text{75}& 7450& 27.04& 50& 0& 0\\ \text{6}\text{.}\text{Pap+HPV}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7925& 27.05& 475& 0.01& 47500\end{array}$

As per the table, option 3 and 6 seems to be economically rationale. Option 3 has an incremental value that is considerably low, together with a positive QALY value. Option 6 too consists of a somewhat lower incremental cost with a positive QALY value. Hence both these options could be considered as economically rational.

Economics Concept Introduction

Introduction:

In determining the economically rational treatment options out of a list, it is important to consider measures such as the incremental cost, incremental QALY and the incremental cost effectiveness ratio. An economically rational option would ideally have a lower incremental cost and a positive QALY value.

(c)

To determine

The best strategy to be recommended from a standpoint of public health.

Explanation of Solution

  $\begin{array}{cccccc}\text{Strategy}& \text{Cost}& \text{QALY}\text{Saved}& \text{Incremental}\text{Cost}& \text{Incremental}\text{QALY}& \text{Incremental}\text{CE}\text{Ratio}\\ \text{0}\text{.}\text{No}\text{screening}& 5000& 26.87& -& -& -\\ \text{1}\text{.}\text{Pap}\text{}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6825& 27.87& 1825& 1& 1825\\ \text{2}\text{.}\text{HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 6950& 27.02& 125& -0.85& -147.05\\ \text{3}\text{.}\text{Pap}\text{}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7275& 27.04& 325& 0.02& 16250\\ \text{4}\text{.}\text{Pap+HPV}\text{every}\text{3}\text{years}\text{to}\text{age}\text{75}& 7400& 27.04& 125& 0& 0\\ \text{5}\text{.}\text{HPV}\text{every}\text{2}\text{years}\text{to}\text{}\text{age}\text{75}& 7450& 27.04& 50& 0& 0\\ \text{6}\text{.}\text{Pap+HPV}\text{every}\text{2}\text{years}\text{to}\text{age}\text{75}& 7925& 27.05& 475& 0.01& 47500\end{array}$

As per the table, option 6 could be considered the best strategy to be recommended from a public health standpoint. The option included both the tests Pap and HPV, with a reasonable incremental cost as well as a positive QALY value. Hence it could be recommended as the best strategy.

Economics Concept Introduction

Introduction:

When recommending health strategies from the perspective of public health, it is important that they address to the needs of a wider population, at a lower cost. In this regard, out of the strategy options given, the one with a considerably low incremental cost together with a positive QALY value must be selected.