A Review and Analysis of Economic Models of Prevention Benefits. A Review and Analysis of Economic Models of Prevention Benefits : Table 3


: Table 3

OrganizationTask Force on Community Preventive ServicesUS Preventive Services Task Force (USPSTF)P13F [14]Advisory Committee on Immunization Policy (ACIP)National Commission on Prevention Priorities (NCPP)OMB Guidance on Regulatory Impact AssessmentNICEWHO-CHOICE
PurposeTo establish method of adjusting results of studies for comparability; based on PCEHM reference caseTo promote economic evaluations of preventive interventions as CEAs to inform recommendationsTo ensure the quality of economic data presented to ACIP and its working groupsRecommendations for US health plan coverage policyTo inform policy makers about costs and benefits of proposed regulations vis a vis alternative policiesConducted for both new technology assessment and clinical guidelines for NHSNational priority setting; resource allocation
Acceptable Framework (BCA, CEA, etc.)Cost, CEA (including cost-utility), or BCACEA (including cost-utility)CEA (including cost utility), BCACEABCA, CEA using both natural and HALY measuresCEA, using QALYsGeneralized CEA
PerspectiveSocietalSocietalSocietal; other perspectives when strong justification providedSocietalSocietalAll health effects on individualSocietal
Individual studies/systematic reviewsSystematic reviewsSystematic reviews and standards for individual CEAsIndividual economic evaluationsSystematic reviewsIndividual studies/systematic reviewsSystematic reviewSystematic review
Study populationUS populationGeneralUS populationUS populationUS population affected by regulationUK population or similar economically developed countryAny country or region; specifies 14 epidemiology sub-regions
Time frame of studies /analytic horizonAs relevantAs relevant; specifySpecify and justifyLifetime; multigenerational, as appropriateAs relevantLong enough to include all relevant costs and benefitsAssume intervention implemented for 10 years; costs and health effects over the lifetime of those affected
Discount rate3%3%Appropriate to stated perspective; specify3%7% when the main effect of a regulation is to displace or alter the use of capital in the private sector; 3% when regulation primarily and directly affects private consumption3.5%3%; 6% and/or country-specific in sensitivity analysis
Intervention(s)Community health promotion and disease preventionReasonable evidence that intervention is effectiveSelected interventions for which evidence of effectiveness is strong or sufficient based on explicit criteriaRecommended interventions by USPSTF, ACIP, or Task Force on Community Preventive ServicesRegulatory or other actions to abate risks to life and healthAppropriate intervention for guidelineInterventions that interrelate are considered as a set
Comparator(sAlternative strategiesAlterative preventive service strategiesAdjusted summary measuresClinical preventive servicesStatus quo; alternative approachesTherapies in use in the NHS; Current best practicesThe “null set” –the situation if none of the set of interventions were in place
Data sourcesStudies conducted in Established Market EconomiesPublished studiesPublished studiesPublished studiesPublished studiesPublished studiesN/S
Valuation of health benefits($, QALYs, LYS, cases averted)QALYs preferred; DALYs if used in original study; impute 0.3 QALYs lost annually for most health conditions, if not estimated in studyQALYs preferred, may be LYs or cases of disease avertedQALYs, natural units, as relevant for perspective adoptedQALYMonetized VSL, HALY measuresQALYs; EQ 5-D preferred instrumentDALYs
CostsUS dollars, converted using purchasing power parity rates, if necessary, adjusted to 1997 base year by CPI or MCPI, depending on nature of costs; productivity costs subtracted, per PCCEHMCost of intervention itself plus those induced my intervention (e.g. side effects)Differentiate between direct medical, direct non-medical, indirect (i.e., productivity), and intangible costs (included when relevant)Important medical costs for screening, counseling, pharmaceutical treatment, follow-up diagnostic tests, and hospitalizations for treatments following screening; time and intervention itselfWTP/WTA are acceptable for capturing “opportunity cost”; market price may not reflect true value of good/services, so the value to society should be calculated; revealed is preferred over stated preferences; benefit-transfer methods (taking estimates and applying to a new context)  should be a last resortCosts that NHS and Personal Social Services (PSS) bears, not those borne by patients or caregiversDirect medical costs and resources to access care (e.g., travel). Substantial time costs treated like  productivity impacts, and reported separately in physical units
Sensitivity analysesSingle-variable sensitivity analysis on the final adjusted value of the summary measureAs appropriateTo identify influential variables. Multivariate analyses strongly encouraged.  Ranges must be clinically or policy relevantSingle and multivariate analyses to test for sensitivity to uncertaintySingle and multivariate analyses to find “switch points”: when net benefits or low cost alternatives switch signSingle and multivariate analyses as appropriateYes (e.g., of discount rates)
Abstraction instrument? Quality rating?Abstraction: yes/quality rating: noYes/yesPresentation format specifiedYes/yesAbstraction: yes/quality rating: noYes/yesNo/no
Distributional/ equity analysis required?NoNoNoNoYesNoYes