What might be the impact of lower than anticipated adherence on incremental cost and incremental effectiveness?
Suppose a new method of screening for colorectal cancer has been developed. The new screening method Show more Suppose a new method of screening for colorectal cancer has been developed. The new screening method is assumed to be more acceptable than currently available screening methods. The table below summarizes the estimated costs and outcomes for alternative screening methods for males at age 55: Strategy Adherence Cost QALY Cost QALY ICER ($/QALY) ICER ($/QALY) Screen A 50% $ 60000 15 Screen B 25 72000 20 (72000 60000) = 12000 (20 15) = 5 (20 15) = 5 (12000/5) = 2400 Screen C 60 96000 22 (96000 72000) = 24000 (22 20) = 2 (22 20) = 2 (24000/2) = 12000 Screen D 50 100000 24 (100000 96000) = 4000 (24 22) = 2 (24 22) = 2 (4000/2) = 2000 New Screen 85 220000 25 (220000 100000) = 120000 (25 24) = 1 (25 24) = 1 (120000/1) = 120000 ( I filled in the Cost QALY and ICER. Please double check to ensure that my computations are correct.) The adherence column refers to the percentage of men in the target population for the screening strategy who would agree to be screened for each screening strategy. The estimates of expected costs and effectiveness for each screening strategy reported in the table are based on an intention to treat approach. For example for each 1000 men in the target population if the adherence rate is 50% the expected cost for the strategy is based on the costs for the 500 men who accept screening and costs for the 500 men who do not (likewise for effectiveness). A) On your answer sheet complete an incremental cost analysis for the alternative strategies by replicating and completing the table above. [Be sure to check for dominated strategies.] What is the final ICER for New Screen? DISCUSS. B) The assumed adherence to the new screening method is based on pre-market survey responses not actual rates of use in practice. What might be the impact of lower than anticipated adherence on incremental cost and incremental effectiveness? EXPLAIN. Show less
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