Chapter 3
Generalizability
It can be applied to and be effective for other diverse populations
Relative Risk
Relative risk is how strongly disease and exposure are associated
Example:
If we say that the RR is 9 for liver cancer due to binge drinking = drinkers have 9 times the risk for lover cancer compared to non-binge drinkers
CMA
Cost minimization Analysis
Compares costs of programs with identical benefits
Demonstrate that outcomes are identical, then measure costs of the programs and choose the one with the lowest costs
QALY
Quality Adjusted Life Years
Health Impact Assessment
Determines the risk and benefit of interventions that are non-health related (e.g., transportation and subsidized housing)
Publication Bias
The higher likelihood of journal editors to publish positive or “new” findings in contrast to negative studies or studies without statistically significant results
False-positive findings are over represented
Confounders / Confounding Variables
A variable that unpredictably or unexpectedly impacts the dependent variable
CBA
Cost Benefit Analysis
Evaluates 2 or more programs with non-comparable outcomes converted to monetary benefits
Value all outcomes of a program in dollars, measure costs, calculate ICER or Net Benefit (benefits – costs).
DALY
Disability Adjusted Life Years
Dose-response relationship
Increasing exposure increases the risk
Systematic Errors
when there is a tendency to have the same error occur over time that impacts the variable
Examples: Selection bias /Information bias / Confounding bias
CUA
Cost Utility Analysis
Compares the costs and benefits of a program, with benefits measured in health-related quality of life years (QALYs)
“Is the increase in health-related quality of life worth the cost of the program?
Measure all health outcomes in QALYs, measure costs, calculate ICER.
Example of ICER: $10,000 per quality-adjusted life year (QALY) saved
Social Return on Investment
Adds some monetary and non-monetary (e.g., social) benefits to ROI: improved productivity measured in dollars and some improved quality of life to beneficiaries
Think - “Will an activity pay for itself if these additional benefits to our employees are considered?”
Temporality
Exposure happens before the disease is present
Selection Bias
people who join a study are different from those who do not
CEA
Cost Effectiveness Analysis
Compares cost and benefits of a program with benefits measured in naturally occurring health units
Choose a single health outcome, measure that for both programs, measure costs, calculate ICER.
Why do economic evaluations
Analyze alternative financial incentives and behavioral health strategies
Understand the impact of regulations
Inform policies
Set priorities
Manage resources more effectively
Establish program value
Prevention Fraction (PF) and PF equation
exposure to a policy or program may protect against disease
Pe (1-relative risk) =PF
Information Bias
when key information is either measured, collected or interpreted inaccurately
“observation bias” and “measurement bias”
ICER
Incremental Cost-effectiveness ratio.
Incremental, or extra, cost of intervention divided by incremental benefits
If we do program B instead of program A it will cost $x per unit of benefit, e.g. $10,000 per year of life saved
Economic Perspectives
Economic evaluations can be done using narrow, intermediate, or broad perspectives
In public health, want the social perspective
Reflects spending tax dollars raised from all
Includes everyone’s costs and benefits
Goes from narrow to broad (individual to community)