Beruflich Dokumente
Kultur Dokumente
)URP&OLQLFDO7ULDOV
$QGUHZ5:LOODQ3K'
&OLQLFDO7ULDOV0HWKRGRORJLVW
2QWDULR&KLOG+HDOWK6XSSRUW8QLW
6LFN.LGV 5HVHDUFK,QVWLWXWH7RURQWR
3URIHVVRURI%LRVWDWLVWLFV
'DOOD /DQD6FKRRORI3XEOLF+HDOWK
8QLYHUVLW\RI7RURQWR
0RGHO'HILQLWLRQV
&RQVLGHUWKHFRVWHIIHFWLYHQHVVFRPSDULVRQEHWZHHQDQHZKHDOWK
FDUHLQWHUYHQWLRQUHIHUUHGWRDVTreatmentGHQRWHGTZLWK
FXUUHQWSUDFWLFHUHIHUUHGWRDVStandardGHQRWHGS
TreatmentT
YHUVXV
StandardS
0RGHO'HILQLWLRQV
:HQHHGWRHVWLPDWH
' e WKHGLIIHUHQFHLQPHDQHIIHFWLYHQHVV eT eS
VXUYLYDO ' e SUREVXUYLYDOT±SUREVXUYLYDOS
VXUYLYDOWLPH ' e PHDQVXUYLYDOWLPHT±PHDQVXUYLYDOWLPHS
TXDOLW\DGMXVWHGVXUYLYDOWLPH
'e PHDQTDVXUYLYDOWLPHT±PHDQTDVXUYLYDOWLPHS
' c WKHGLIIHUHQFHLQPHDQFRVW cT cS
$OVRQHHGHVWLPDWHVRIV 'Ö e V 'Ö c DQG C 'Ö e 'Ö c
0RGHO'HILQLWLRQV
/HW O EHWKHWKUHVKROGYDOXHIRUDXQLWRIHIIHFWLYHQHVV
VXUYLYDO O WKUHVKROGYDOXHWRVDYHDOLIH
VXUYLYDOWLPH O WKUHVKROGYDOXHIRUD\HDURIOLIH
TXDOLW\DGMXVWHGVXUYLYDOWLPH
O WKUHVKROGYDOXHIRUDTXDOLW\DGMXVWHGOLIH\HDU4$/<
'HILQHLQFUHPHQWDOQHWEHQHILW,1%DV
bO { O' e ' c
³LQFUHPHQWDO´EHFDXVHLWLVGLIIHUHQFHEHWZHHQTDQGSDQGLWLV³QHW´RIFRVWV
,1% O' e ' c OeT eS cT cS OeT cT OeS cS 1%T±1%S
0RGHO'HILQLWLRQV
&RVWHIIHFWLYHQHVV3ODQH
1: 'c 1(
'e 'c
'e
6: 6(
0RGHO'HILQLWLRQV
'c 'c
LHLII O ! {R ' e ! RU O {R ' e
'e 'e
RLVUHIHUUHGWRDVWKHLQFUHPHQWDOFRVWHIIHFWLYHQHVVUDWLR,&(5
TLVFRVWHIIHFWLYHLII
bO !
25
0RGHO'HILQLWLRQV
'c
,QFUHPHQWDOFRVWHIIHFWLYHQHVVUDWLR,&(5 R 'c
'e 'e
WKHDGGLWLRQDOFRVWSHUSDWLHQW u 117
DGGLWLRQDOFRVWWRUHDOL]HDQH[WUDXQLWRIHIIHFWLYHQHVV
IURPXVLQJTUDWKHUWKDQS
IRUVXUYLYDO,&(5 FRVWRIVDYLQJDOLIH
IRUVXUYLYDOWLPH,&(5 FRVWRIDQDGGLWLRQDO\HDURIOLIH
IRUTXDOLW\DGMXVWHGVXUYLYDOWLPH
,&(5 FRVWRIDQDGGLWLRQDO4$/<
&RVWHIIHFWLYHQHVV3ODQH
1: 'c 1(
R!O LI ' e !
ORVHORVH WUDGHRII RO LI ' e
'e 'c
VORSH R ǻ c ǻ e
'e
RO LI ' e !
WUDGHRII ZLQZLQ R!O LI ' e
6: 6(
,QIHUHQFHRQ,QFUHPHQWDO1HW%HQHILW
H bO d YHUVXV A b O !
1(4XDGUDQW 'Ö e ! 'Ö c !
,1%
bÖO z V >bÖO @
bÖO O'Ö e 'Ö c
'Ö e
ORZHUOLPLW
bÖO z V >bÖO @
IRUR
RÖ XSSHUOLPLW O4$/<
'Ö c IRUR
,1%
bÖO O'Ö e 'Ö c
ORZHUOLPLW
'Ö c
IRUR
RÖ XSSHUOLPLW O4$/<
IRUR
1:4XDGUDQW 'Ö e 'Ö c !
ORZHUOLPLW
IRUR O4$/<
RÖ
'Ö c
,1%
'Ö c
XSSHUOLPLW
RÖ IRUR
O4$/<
ORZHUOLPLW
IRUR
bÖO O'Ö e 'Ö c
)LHOOHU&RQILGHQFH/LPLWVIRUWKH,&(5
'Ö c
(VWLPDWHRIWKH,&(5 RÖ LVELDVHGEXWFRQVLVWHQW
'Ö e
)LHOOHUFRQILGHQFHOLPLWVIRUWKH,&(5JLYHQE\
^
RÖ z
c r z a b c z ab c z
a ` ZKHUH
V 'Ö e V 'Ö c C 'Ö e 'Ö c
a b c
'Ö e 'Ö c 'Ö e 'Ö c
)LHOOHU /LPLWVDVD%RZWLH
'c
'Ö Ö
e 'c
'e
)LHOOHUOLPLWVVWUDGGOLQJWKHYHUWLFDOD[LV
'c
'c
'Ö Ö
e 'c
'e 'e
'Ö Ö
e 'c
&(3ODQH &(3ODQH
$&RQILGHQFHLQWHUYDOWR f %&RQILGHQFHLQWHUYDOWR f
DQG f WR DQG f WR
3UREOHPVZLWK,&(5V
1: 'c 1(
'eO 'c
ORVHORVH WUDGHRII
'e
'eO ! 'c
WUDGHRII ZLQZLQ
6: 6(
1RWSURSHUO\RUGHUHGLQ³ZLQZLQ´
3UREOHPVZLWK,&(56 DQG³ORVHORVH´TXDGUDQWV
'c
(IIHFW &RVW
\UV
7 'e
7
7
6 ,&(5
'
'
'
EHWWHUWKDQEHWWHUWKDQ
,QFUHPHQWDO1HW%HQHILWRQWKH&(3ODQH
'c
'e O'e
O' e ' c
'e 'c
'e
O' e ' c b O
VORSH O
3UREOHPVZLWK,&(566ROYHGE\,1%
'c
'e EHWWHUWKDQEHWWHUWKDQ
VORSH O ,1%!,1%!,1%
,1%
,1%
,1%
&RVWHIIHFWLYHQHVV$FFHSWDELOLW\&XUYHV&($&
3ORWRIWKHSUREDELOLW\WKDWTLVFRVWHIIHFWLYH
DVDIXQFWLRQRIWKHWKUHVKROGYDOXHIRUKHDOWKRXWFRPH
7KDWLV3UO' e 'c ! DVDIXQFWLRQRIO A O
%D\HVLDQFRQFHSWEXWWKH&($&LVQRWDSUREDELOLW\GLVWULEXWLRQ
&DQKDYHQHJDWLYHVORSH
&RVWHIIHFWLYHQHVV$FFHSWDELOLW\&XUYHV&($&
'c
'Ö Ö
e 'c
'e
&RVWHIIHFWLYHQHVV$FFHSWDELOLW\&XUYHV
&DQEHJLYHQE\&($&O
) bÖO V bÖO
:KHUH)ÂLVWKHcdf IRUDVWDQGDUGQRUPDOUDQGRPYDULDEOH
3UT LVFRVWHIIHFWLYH
3U ' e !
3U ' c
//R RÖ 8/R O
3DUDPHWHU(VWLPDWLRQ
SDWLHQWV
1RGLIIHUHQFHLQVXUYLYDO
%HWWHUSDOOLDWLRQZLWKT
&RVWGDWDRQSDWLHQWVIURPWKHODUJHVWFHQWUHV
5HWURVSHFWLYHFKDUWUHYLHZLQFOXGHGKRVSLWDODGPLVVLRQVRXWSDWLHQW
YLVLWVLQYHVWLJDWLRQVWKHUDSLHVDQGSDOOLDWLYHFDUH
4XDOLW\DGMXVWHGVXUYLYDOXVLQJ(257&4/4&
3URVWDWH&DQFHU([DPSOH
/HWejiDQGcjiEHWKHREVHUYHGHIIHFWLYHQHVVDQGFRVW
UHVSHFWLYHO\IRUSDWLHQWiRQDUPj TS
8QSRROHG 3RROHG
S nj
S nj
e ji eÖ j § nT nS ·
¦ ¦ e ji eÖ j
VÖ 'Ö e VÖ eÖT VÖ eÖS ¦ ¦ n n
¨ ¸
j T i
nT nS
j T i j j © nT nS ¹
S nj
S nj
c ji cÖ j § nT nS ·
¦ ¦ c ji cÖ j
VÖ 'Ö c VÖ cÖT VÖ cÖS ¦ ¦ n n
¨ ¸
j T i
nT nS
j T i j j © nT nS ¹
S nj
e ji eÖ j c ji cÖ j
CÖ 'Ö e 'Ö c CÖ eÖT cÖT CÖ eÖS cÖS ¦¦ n j n j
j T i
S nj
§ nT nS ·
¦ ¦ e ji eÖ j c ji cÖ j
j T i
¨ ¸
© nT nS ¹ nT nS
3URVWDWH&DQFHU([DPSOH
7UHDWPHQW 6WDQGDUG
eÖ j GLIIHUHQFH 'Ö e
VÖ eÖ j VXP VÖ 'Ö e
cÖ j GLIIHUHQFH 'Ö c
VÖ cÖ j VXP VÖ 'Ö c
bÖ O r z VÖ >bÖO @
VÖ >bÖO @ VÖ 'Ö e O VÖ 'Ö c CÖ 'Ö e 'Ö c O
bÖ O r VÖ >bÖO @
O O
'Ö c
8/ 'c
// 'c
// 'c
// 'c
O
RÖ
//R
8/R
bÖ
&RVWHIIHFWLYHQHVV$FFHSWDELOLW\&XUYH
//R
RÖ
8/R
O
SDWLHQWVIURPVLWHVLQFRXQWULHV
ZLWK67HOHYDWHG$0,UDQGRPL]HGWRDUPV
+HSDULQIXOOGRVHWHQHFWHSODVHXQIUDFWLRQDWHGKHSDULQ
(QR[DSDULQIXOOGRVHWHQHFWHSODVHHQR[DSDULQ
$EFL[LPDEKDOIGRVHWHQHFWHSODVHXQIUDFWLRQDWHGKHSDULQDEFL[LPDE
GXUDWLRQRILQWHUHVW GD\V
&RPSRVLWHPHDVXUHRIHIIHFWLYHQHVV
$66(17WULDO
/HWeji LISDWLHQWiRQDUPjKDVDVXFFHVVRWKHUZLVH
7KHQ eÖ j SURSRUWLRQRIVXFFHVVRQDUPj
C 'Ö e 'Ö c
cT ^` nT eÖT cÖT c6^` nSeÖScÖS
nT nT nS nS
V
X
P
R
I
F
R
V
W
I
R
U
S
D
W
L
H
Q
W
V
Z
L
W
K
V
X
F
F
H
V
V
nj
ZKHUH c j ^` ¦ e ji c ji
i
$66(177ULDO
$EFL[LPDETYV+HSDULQS
bÖ O r z VÖ >bÖO @
V >bÖ O @ VÖ 'Ö e O VÖ 'Ö c CÖ 'Ö e 'Ö c O
bÖ O r VÖ >bÖO @
O O
$EFL[LPDE T
YV+HSDULQS
'Ö c
8/ 'c
// 'c
O // 'c
// 'c
RÖ
//R
//R
RÖ
8/R
O
VNHZHGFRYDULDWHVUDQGRPHIIHFWVFHQVRUHG <111
0LWR[DQWURQH3UHGQLVRQHTYHUVXV3UHGQLVRQHDORQHS
IRUV\PSWRPDWLFKRUPRQHUHVLVWDQWSURVWDWHFDQFHU
,WHQGWRXVHDJDPPDGLVWULEXWLRQIRUFRVWV
IDFLOLWDWHGE\WKHSURFHGXUH*(102'LQ6$6
6$6&RGH
FRPPHQWHVWLPDWH'e DQGLWVYDULDQFH
WUHDWPHQW IRUT DQGWUHDWPHQW IRUS
GLVW ELQIRUELQDU\PHDVXUHIRUHIIHFWLYHQHVV
SURF JHQPRG GDWD GDWDVHWGHVF
PRGHOTDOZ WUHDWPHQWGLVW QRUPDOOLQN LGHQWLW\
RXWSXWRXW HSUHGLFWHG SUHGBH
UXQ
FRPPHQWHVWLPDWH'c DQGLWVYDULDQFH
SURF JHQPRG GDWD GDWDVHWGHVF
PRGHOFRVW WUHDWPHQWGLVW JDPPDOLQN LGHQWLW\
RXWSXWRXW FSUHGLFWHG SUHGBF
UXQ
&($&VIRU3URVWDWH([DPSOH
3UT LV&(
JDPPD
QRUPDO
O
6XPPDU\,
6XPPDU\,,
,IVNHZLQJLVLJQRUHGDQGWKHUHDUHQRFRYDULDWHVRUUDQGRPHIIHFWV
DQGWKHGDWDDUHQRWFHQVRUHGWKHQSDUDPHWHUHVWLPDWLRQ
LVVLPSO\6WDWV
)RURWKHUVLWXDWLRQVVHH
:LOODQDQG%ULJJVThe Statistical Analysis of
Cost-effectiveness Data:LOH\ 6RQV&KLFKHVWHU
6XPPDU\,,,
:LWKSDUDPHWHUHVWLPDWHVRQHFDQFDOFXODWH
x ,&(5DQGFRQILGHQFHOLPLWV
x ,1%DQGFRQILGHQFHOLPLWV
x &RVWHIIHFWLYHQHVVDFFHSWDELOLW\FXUYH
7XWRULDO
$QGUHZ5:LOODQ3K'
&OLQLFDO7ULDOV0HWKRGRORJLVW
2QWDULR&KLOG+HDOWK6XSSRUW8QLW
6LFN.LGV 5HVHDUFK,QVWLWXWH7RURQWR
3URIHVVRURI%LRVWDWLVWLFV
'DOOD /DQD6FKRRORI3XEOLF+HDOWK
8QLYHUVLW\RI7RURQWR
'D\[OV[