PUB HLTH 7082 - Health Economic Evaluation and Decision Making

North Terrace Campus - Semester 1 - 2018

The course is designed to give a broad and practical introduction to health economic evaluation and decision making. The course introduces the concepts underlying the economic evaluation of healthcare technologies and services, including outcome measurement and the assessment of opportunity costs. Module 1 reviews key concepts in economic evaluation, including the QALY as a measure of outcome in economic evaluation and the estimation of opportunity costs to inform decision making. Module 2 covers cost-effectiveness analyses undertaken alongside clinical studies and the use of decision trees as a framework for economic evaluation. The remaining four modules focus on the concepts and application of model-based economic evaluation to predict long term costs and benefits and hence capture all important differences between comparator interventions. The course covers the use of decision trees and state transition models, involving practical sessions in which participants develop, populate, and analyse cost-effectiveness models. The course provides state of the art knowledge on key theoretical and practical issues in the application of health economics to inform the efficient and equitable allocation of healthcare resources. On completion of the course, students will have the necessary knowledge and materials to undertake a basic health economic evaluation; to explore methods for more complex evaluations; and to critically review the conduct and validity of presented or published evaluations.

  • General Course Information
    Course Details
    Course Code PUB HLTH 7082
    Course Health Economic Evaluation and Decision Making
    Coordinating Unit Public Health
    Term Semester 1
    Level Postgraduate Coursework
    Location/s North Terrace Campus
    Units 3
    Contact Up to 3 hours per week
    Available for Study Abroad and Exchange N
    Course Description The course is designed to give a broad and practical introduction to health economic evaluation and decision making. The course introduces the concepts underlying the economic evaluation of healthcare technologies and services, including outcome measurement and the assessment of opportunity costs. Module 1 reviews key concepts in economic evaluation, including the QALY as a measure of outcome in economic evaluation and the estimation of opportunity costs to inform decision making. Module 2 covers cost-effectiveness analyses undertaken alongside clinical studies and the use of decision trees as a framework for economic evaluation. The remaining four modules focus on the concepts and application of model-based economic evaluation to predict long term costs and benefits and hence capture all important differences between comparator interventions. The course covers the use of decision trees and state transition models, involving practical sessions in which participants develop, populate, and analyse cost-effectiveness models. The course provides state of the art knowledge on key theoretical and practical issues in the application of health economics to inform the efficient and equitable allocation of healthcare resources. On completion of the course, students will have the necessary knowledge and materials to undertake a basic health economic evaluation; to explore methods for more complex evaluations; and to critically review the conduct and validity of presented or published evaluations.
    Course Staff

    Course Coordinator: Professor Jonathan Karnon

    Course Coordinator: Jonathan Karnon
    Phone: +61 8313 3562
    Email: jonathan.karnon@adelaide.edu.au
    Location: Level 9, Adelaide Health and Medical Sciences building

    Student & Program Support Services Hub
    Email: askhealthsc@adelaide.edu.au
    Phone: +61 8313 0273


    Course Timetable

    The full timetable of all activities for this course can be accessed from Course Planner.

  • Learning Outcomes
    Course Learning Outcomes

    Interpret and appropriately apply the key concepts of health economic evaluation, including the strengths and weaknesses of the quality adjusted life year (QALY) as a measure of outcome

    Debate the relative merits of alternative approaches to healthcare decision making and the estimation of opportunity costs

    Understand the role, application and limitations of within study economic evaluation to inform funding decisions

    Describe the components of a decision tree, have practical experience in their implementation and understand when it is appropriate to use a decision tree

    Recognise the decision making contexts in which state transition models are appropriate and understand the process of defining model structures and assumptions

    Identify relevant data sources required for the health economic evaluation of healthcare technologies, and experience in the analysis of data to estimate evaluation input parameters

    Implement, validate, analyse and write-up the results of basic cost-effectiveness models, demonstrating sound knowledge and skills to apply analytic thinking to real world problem solving

    University Graduate Attributes

    This course will provide students with an opportunity to develop the Graduate Attribute(s) specified below:

    University Graduate Attribute Course Learning Outcome(s)
    Deep discipline knowledge
    • informed and infused by cutting edge research, scaffolded throughout their program of studies
    • acquired from personal interaction with research active educators, from year 1
    • accredited or validated against national or international standards (for relevant programs)
    1-5
    Critical thinking and problem solving
    • steeped in research methods and rigor
    • based on empirical evidence and the scientific approach to knowledge development
    • demonstrated through appropriate and relevant assessment
    2-7
    Teamwork and communication skills
    • developed from, with, and via the SGDE
    • honed through assessment and practice throughout the program of studies
    • encouraged and valued in all aspects of learning
    6-7
    Career and leadership readiness
    • technology savvy
    • professional and, where relevant, fully accredited
    • forward thinking and well informed
    • tested and validated by work based experiences
    1-7
    Intercultural and ethical competency
    • adept at operating in other cultures
    • comfortable with different nationalities and social contexts
    • Able to determine and contribute to desirable social outcomes
    • demonstrated by study abroad or with an understanding of indigenous knowledges
    2, 7
    Self-awareness and emotional intelligence
    • a capacity for self-reflection and a willingness to engage in self-appraisal
    • open to objective and constructive feedback from supervisors and peers
    • able to negotiate difficult social situations, defuse conflict and engage positively in purposeful debate
    7
  • Learning Resources
    Required Resources
    No single general textbook covers the whole subject matter of this course. Much of the reading resources for this course will be
    sourced from peer-reviewed journals available electronically through the Barr Smith Library and from official and semi-official reports appearing on the World Wide Web. There will be assigned readings to complement the lectures and practicals. These readings will be
    available on the University Intranet (MyUni: https://myuni.adelaide.edu.au/) to which all enrolled students will have access.
    Recommended Resources
    Although the course does not follow a set textbook, the following two books are recommend, which can be used as general reference books for the topics covered in this course:

    M Drummond, M Sculpher, G Torrence, B O'Brien, G Stoddart, Methods for the Economic Evaluation of Health Care Programmes (3rd Edition) 2005; ISBN10: 0198529453: Oxford University Press.

    The ‘blue book’, as it is known by health economists. A comprehensive account of all the methodological issues involved in health economic evaluation.

    A Briggs, M Sculpher, K Claxton, Decision Modelling for Health Economic Evaluation, 2006, ISBN10: 0198526628. Oxford University Press.

    A practical and accessible introduction to the rationale and application of decision models as a framework for health economic
    evaluation.

    The online lectures provide links to a wide range of journal papers and other resources. The following journal papers have been assembled in the form of a ‘reading brick’. The reading brick brings together a selection of the linked resources to provide general background reading on health economic evaluation; model-based economic evaluation and decision-making using economic evaluation.

    Health Economic evaluation (general & within study)

    Simoens S, Health Economic Assessment: A Methodological Primer, Int. J. Environ. Res. Public Health 2009; 6:2950-2966.

    This paper provides a general introduction to the conduct of health economic evaluation, describing the main concepts or elements to be included in the evaluation.

    Brazier J, Ratcliffe J. The measurement and valuation of health for economic evaluation, in International Encyclopedia of Public Health 2008.

    General introduction to the Quality Adjusted Life Year (QALY).

    Trial-based economic evaluation

    Petrou S, Gray A, Economic evaluation alongside randomised controlled trials: design, conduct, analysis, and reporting, BMJ 2011; 342:d1548.

    “collecting data at the same time as evidence of effectiveness maximises the information available for analysis but requires proper consideration at the design stage.”

    Tay-Teo K et al. Economic Evaluation alongside a Phase II, Multi-Centre, Randomised Controlled Trial of Very Early Rehabilitation after Stroke (AVERT). Cerebrovasc Dis 2008;26:475–481.

    A comprehensively presented economic evaluation alongside a clinical trial.

    Model-based economic evaluation

    Buxton MJ, Drummond MF, Van Hout BA, Prince RL, Sheldon TA, Szucs T, Vray M, Modelling in economic evaluation: an unavoidable fact of life, Health Economics 1997; 6(3):217–227.

    An important summary of the rationale for decision modelling as a framework for health economic evaluation.

    Roberts et al, Conceptualizing a Model: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-2, Value in Health 2012; 15(6):804-11.

    Guidelines on the process of defining the model problem and model structure.

    Karnon J, Brown J, Selecting a decision model for economic evaluation: a case study and review, Health Care Management Science 1998; 1: 133-140.

    A descriptive comparison of alternative decision modelling techniques.

    Briggs A, Sculpher M, An introduction to Markov modelling for economic evaluation, PharmacoEconomics 1998; 13(4):397-409.

    An introductory paper on the most commonly applied health economic decision modelling technique.

    Siebert et al, State-Transition Modeling: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-3, Value in Health 2012; 15(6):812-20.

    Guidance on the application of state transition models for economic evaluation

    Eddy et al, Model Transparency and Validation: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-7, Value in Health 2012; 15(6):843-50.

    Guidelines on model reporting and validation.

    Vemer P et al and the AdViSHE Study Group. AdViSHE: a New Tool to Report Validation of Health-Economic Decision Models. Pharmacoeconomics 2016; 34(4):349-61.

    Framework for the validation of models for economic evaluation.

    Briggs et al, Model Parameter Estimation and Uncertainty: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-6, Value in Health 2012; 15(6):835-42.

    Guidance on the conduct of uncertainty analysis of model-based economic evaluation.

    Karnon J, Vanni T, Calibrating Models in Economic Evaluation, Pharmacoeconomics 2011; 29 (1): 51-62.

    An applied introduction to probabilistic calibration for model-based economic evaluation.

    Decision-making (using economic evaluation)

    Gafni A, Birch S, Incremental cost-effectiveness ratios (ICERs): The silence of the lambda, Social Science & Medicine 2006; 62(9):2091-2100.

    An introduction, and critical appraisal of the concept of a threshold ICER.

    Mccabe et al, The NICE cost-effectiveness threshold: what it is and what that means; Pharmacoeconomics 2008; 26 (9): 733-744.

    A critical assessment of NICE’s use of the incremental cost-effectiveness ratio (ICER) threshold.

    Paulden M, McCabe C, Karnon J, Achieving Allocative Efficiency in Healthcare: Nice in Theory, not so NICE in Practice? PharmacoEconomics (2014) 32:315–318.

    Discussion of theoretical and practical issues around the cost-effectiveness threshold.

    Henry DA, Hill SR, Harris A, Drug prices and value for money: The Australian Pharmaceutical Benefits Scheme, JAMA. 2005;294:2630-2632.

    Commentary on the use of cost-effectiveness in an Australian decision making process.




    Online Learning
    MyUni is the primary entry point to online learning at The University of Adelaide. Students can connect to MyUni at https://myuni.adelaide.edu.au/

    All course materials, including on-demand lectures, video solutions for practicals and recordings on the real-time online sessions and other resources are posted in MyUni.
  • Learning & Teaching Activities
    Learning & Teaching Modes
    This course gives a high priority to interaction between the student and the academic staff, and amongst students. The course comprises six modules. Each module includes four to five on-line on-demand lectures, each of which include multiple choice or short answer questions that are designed to check student comprehensive of key concepts. Each module also include an Excel spreadsheet-based practical in which students gain practical experience in the applying the content of the Module’s lectures. Detailed workbooks are published for each of the six practicals. Video solutions of course co-ordinator working through the workbooks are published and a live two hour on-line session is held for each of the six modules to discuss queries around either the lectures or practicals.

    Students can also post questions and answers to a discussion board. Monitored by the course coordinator, students will be
    encouraged to answer each other’s questions. Assignments provide an opportunity to undertake exploratory and in-depth analysis of the key concepts introduced in the course.
    Workload

    The information below is provided as a guide to assist students in engaging appropriately with the course requirements.

    Three hours of face-to-face teaching has been allocated for each of the 12 semester weeks, comprising a mix of lectures, and computer and non-computer-based practical sessions. In between these sessions, students will be expected to consolidate content knowledge via assessed and non-assessed assignments.
    Learning Activities Summary
    Module Content
    1 Key concepts and components; Introduction to Quality Adjusted Life Years; Within Study economic evaluation.
    2 Opportunity cost and the cost-effectiveness threshold; Decision trees for economic evaluation
    3 Extrapolating costs and outcomes; State transition models; Defining model structures; Introduction to model implementation.
    4 Estimating input parameter values (transition probabilities; treatment effects; costs; and utility values).
    5 Uncertainty analysis (bootstrapping; defining probability distributions; forms of analysis;
    interpretation).
    6 Model performance evaluation (alternative forms of validation, with focus on model calibration)
    Specific Course Requirements
    N/A
    Small Group Discovery Experience
    N/A
  • Assessment

    The University's policy on Assessment for Coursework Programs is based on the following four principles:

    1. Assessment must encourage and reinforce learning.
    2. Assessment must enable robust and fair judgements about student performance.
    3. Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
    4. Assessment must maintain academic standards.

    Assessment Summary

    ASSESSMENT TASK

    TASK TYPE

    WEIGHTING

    COURSE LEARNING OUTCOME(S)

    Within lecture multiple choice and short answer questions

    Formative

    -

    1-7

    Short answer questions on decision making and opportunity costs

    Summative

    40%

    1,2

    Replication and analysis of applied cost-effectiveness model

    Summative

    60%

    3-7

    Assessment Related Requirements
    N/A
    Assessment Detail
    ..
    Submission
    Extensions
    All extensions for assignments must be requested, at the latest, by the last working day before the due date of submission.   Extensions will generally be granted only on medical or genuine compassionate grounds.  Supporting documentation must be  provided at the time a student requests an extension.  Without documentation, extensions will not be granted. Late requests for extension will neither be accepted nor acknowledged.

    Only the Course Co-ordinator(s) may grant extensions.

    Supporting documentation will be required when requesting an extension. Examples of documents that are acceptable include: a  medical certificate that specifies dates of incapacity, a police report (in the case of lost computers, car & household theft etc.), a  letter from a Student Counsellor, Education and Welfare Officer (EWO) or Disability Liaison Officer that provides an assessment of  compassionate circumstances, or a letter from an independent external counsellor or appropriate professional able to verify the  student’s situation.  The length of any extension granted will take into account the period and severity of any incapacity or impact  on the student.  Extensions of more than 10 days will not be granted except in exceptional circumstances.  

    Late submission
    Marks will be deducted when assignments for which no extension has been granted are handed in late.

    All assignments, including those handed in late, will be assessed on their merits.  In the case of late assignments where no  extension has been granted, 5 percentage points of the total marks possible per day will be deducted.  If an assignment that is 2  days late is awarded 65% on its merits, the mark will then be reduced by 10% (5% per day for 2 days) to 55%.  If that same  assignment is 4 days late, the mark will be reduced by 20% (5% per day for 4 days) to 45%, and so on.

    The School of Public Health reserves the right to refuse to accept an assignment that is more than 7 days late.

    Assignments submitted after the due date may not be graded in time to be returned on the listed return dates.

    Students submitting examinable written work who request (and receive) an extension that takes them beyond the examination  period are advised that there is no guarantee that their grades will be processed in time to meet usual University deadlines.
     
    Resubmission
    If a student is dissatisfied with an assessment grade they should follow the Student Grievance Resolution Process <https://www.adelaide.edu.au/student/grievance/process/>.  Students who are not satisfied with a particular assessment result should raise their concerns with Course Co-ordinator(s) in the first instance.  This must be done within 10 business days of the  date of notification of the result.  Resubmission of any assignment is subject to the agreement of the Course Co-ordinator(s) and  will only be permitted for the most compelling of reasons.
    Course Grading

    Grades for your performance in this course will be awarded in accordance with the following scheme:

    M10 (Coursework Mark Scheme)
    Grade Mark Description
    FNS   Fail No Submission
    F 1-49 Fail
    P 50-64 Pass
    C 65-74 Credit
    D 75-84 Distinction
    HD 85-100 High Distinction
    CN   Continuing
    NFE   No Formal Examination
    RP   Result Pending

    Further details of the grades/results can be obtained from Examinations.

    Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.

    Final results for this course will be made available through Access Adelaide.

  • Student Feedback

    The University places a high priority on approaches to learning and teaching that enhance the student experience. Feedback is sought from students in a variety of ways including on-going engagement with staff, the use of online discussion boards and the use of Student Experience of Learning and Teaching (SELT) surveys as well as GOS surveys and Program reviews.

    SELTs are an important source of information to inform individual teaching practice, decisions about teaching duties, and course and program curriculum design. They enable the University to assess how effectively its learning environments and teaching practices facilitate student engagement and learning outcomes. Under the current SELT Policy (http://www.adelaide.edu.au/policies/101/) course SELTs are mandated and must be conducted at the conclusion of each term/semester/trimester for every course offering. Feedback on issues raised through course SELT surveys is made available to enrolled students through various resources (e.g. MyUni). In addition aggregated course SELT data is available.

  • Student Support
  • Policies & Guidelines
  • Fraud Awareness

    Students are reminded that in order to maintain the academic integrity of all programs and courses, the university has a zero-tolerance approach to students offering money or significant value goods or services to any staff member who is involved in their teaching or assessment. Students offering lecturers or tutors or professional staff anything more than a small token of appreciation is totally unacceptable, in any circumstances. Staff members are obliged to report all such incidents to their supervisor/manager, who will refer them for action under the university's student’s disciplinary procedures.

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