ANALISIS

EFEKTIVITAS-BIAYA
[AEB, cost-effectiveness analysis, CEA]

Prih Sarnianto
Prinsip Dasar AEB
► Seperti analisis ekonomi lainnya, dasar dari AEB:
Value for Money [VFM]
>> untuk mengukur net benefits dari [health]
treatments, interventions, programs and
policies [TIPP].

► Net benefit tergantung pada:

>> Scope: individual [pasien, provider], payer
[pemerintah, insurer, pemberi kerja, individu],
masyarakat.
>> Time horizon: jangka pendek [< 1 tahun], menengah
[1−5 tahun], panjang [>5−10 tahun].
Value for Money
► Benefit lebih besar daripada biaya?
► TIPP mana yang memberi net benefit tertinggi?

>> Relevansi: are we doing the right thing?

>> Kinerja: Are we doing well?
 Kinerja diukur sepanjang the results chain

Immediate Longer-term
Activities Outputs outcomes outcomes
(Typically within a year) (Up to 15 years)

Economy Efficiency Effectiveness

Cost to complete activities Cost per nurse trained Cost per client that becomes employed
(e.g., cost of recruitment, (e.g., total training costs (e.g., total program costs divided by
course development) divided by graduates) number of patients that achieve a specific
health outcome)
Results chain for a health screening program
Inputs/ Immediate Intermediate Final
Outputs
activities outcomes outcomes outcomes

Resources are mobilized • Outreach • Lower morbidity

• Client
to: programs • Increased and mortality
awareness
• Provide counselling • Increased life
designed and • Increased use participation in
• Design promotional implemented treatment and years
of screening
material • Kits distributed prevention • Reduced health
• Train primary care • Staff trained system costs
providers in the • Increased social
distribution of the and economic
screening kit contribution of
survivors
• Are we getting • Are the activities • What is the cost per unit outcome?
inputs/resources all needed for
at the lowest the outputs? • Has the project/program produced outcomes at
cost? • Are we creating a cost consistent with other approaches?
• Are resources outputs at the • Is this the best/least cost way to get desired
deployed at least lowest cost? outcomes?
cost? • Are the outputs
• Are the Effectiveness
available on time
processes well and to the
organized and required quality?
coordinated?
Efficiency
Economy
Apa itu AEB?
► Definisi:
adalah teknik analisis ekonomi untuk
membandingkan biaya dan hasil [outcomes]
relatif dari dua atau lebih intervensi kesehatan.
Pada AEB, hasil diukur dalam unit non-moneter,
seperti jumlah kematian yang dapat dicegah
atau penurunan mm Hg tekanan darah diastolik.
.
AEB adalah analisis komparatif
Dari dua obat, A dan B, yang memiliki efektivitas
berbeda, berapa biaya per pasien yang sembuh untuk
obat A versus obat B?
>> Digunakan untuk membandingkan dua atau
lebih obat yang tidak therapeutically equivalent.

>> Efektivitas terapi sesuai dengan yang telah

diketahui dari pengukuran terapetik
sebelumnya, misalnya:
→ Jumlah pasien yang sembuh
→ Kematian yang dihindarkan, tahun peningkatan UHH
→ Penurunan tekanan darah atau gula darah
CEA: Steps
Define objectives—which medicine regimen is
preferred to achieve the desired clinical outcome
(e.g., cure)?
List the different options (medicines and other
treatments) to achieve the desired clinical outcome.
Identify and measure for each option: (1) cost and (2)
clinical outcome.
Calculate the incremental cost-effectiveness ratio
[ICER].
Perform sensitivity analyses. Adjust cost of variables
and re-analyze to confirm or refute results.
Incremental Cost-Effectiveness Ratio

(Net costs treatment A – Net costs treatment B)

÷
(Net effects treatment A – Net effects treatment B)

= Additional cost per additional benefit

Example of CEA: Medicine Costs
Cost/unit No. of No. of Total cost
(USD)* units patients (USD)
Medicine A
Medicine cost 40 12 100 48,000
Lab cost 20 1 100 2,000
Adverse event 50 2 100 10,000
Physician 25 2 100 5,000
Total 65,000
Medicine B
Medicine cost 25 12 100 30,000
Lab cost 20 2 100 4,000
Adverse event 50 3 100 15,000
Physician 25 3 100 7,500
Total 56,500
Example of CEA: Benefits
Effectiveness
Medicine A Medicine B
25/100 patients 19/100 patients

Clinical outcome: number of patients with ≥ 1%

decrease in glycosylated hemoglobin over one
year
Example of CEA: Incremental Cost-
Effectiveness
Comparison between medicines A and B for 100
patients for 1 year
Medicine A Medicine B
Net costs USD* 65,000 56,500
Effectiveness
No. patients with ≥ 1%
decrease in glycosylated
hemoglobin 25 19

Incremental Cost Effectiveness Ratio =

(65,000-56,500)/(25-19) = USD1,416.67 per extra patient
with ≥ 1% decrease in glycosylated hemoglobin.
CEA of Two Thrombolytics in Acute Myocardial
Infarction (MI) in Australia (1)
Cost of treatment and mortality rates
• Usual care (UC) of MI: 3.5 million Australia dollars
(AUD)/1,000 cases, 120 die
• UC+ Streptokinase (SK): AUD 3.7 million /1,000
cases, 90 die
• UC + tissue plasminogen activator (tPA): AUD 5.5
million /1,000 cases, 80 die
CEA of Two Thrombolytics in Acute MI in
Australia (2)
Comparison of the Treatments

1. Difference between UC + SK and UC of MI:

Cost of treatment = AUD 3.7 – 3.5 million/1,000 cases

= AUD 0.2 million/1,000 cases
= AUD 200/case

Number of deaths prevented

= 120 – 90
= 30 deaths/1,000 cases treated

Incremental cost effectiveness of SK compared with UC

= AUD 0.2 million/30 lives
= AUD 6,700/life saved
CEA of Two Thrombolytics in Acute MI in
Australia (3)
2. Difference between UC + tPA and UC of MI:

Cost of treatment = AUD 5.5– 3.5 million/1,000 cases

= AUD 2.0 million/1,000 cases
= AUD 2,000/case

Number of deaths prevented

= 120 – 80
= 40 deaths/1,000 cases treated

Incremental cost effectiveness of tPA vs. UC

= AUD 2.0 million/40 lives
= AUD 50,000/life saved
CEA of Two Thrombolytics in Acute MI in
Australia (4)
3. Difference between tPA and SK treatments for MI:

Cost of treatment = AUD 2.0 - 0.2 million/1000 cases

= AUD 1.8 million/1000 cases
= AUD 1,800/case

No. of deaths prevented

= 90 - 80 = 10 deaths/1,000 cases treated

Extra cost effectiveness of tPA over SK

= AUD 1.8 million/10 lives
= AUD 180,000/life saved
CEA of Two Thrombolytics in Acute MI in
Australia (5)
If one has a budget of only AUD 500,000—

For SK = 500,000 ÷ 200

= 2,500 cases
Number of lives that can be saved
= (30 ÷ 1,000) × 2,500
= 75 lives

For tPA = 500,000 ÷ 2,000

= 250 cases
Number of lives that can be saved
= (40 ÷ 1,000) × 250
= 10 lives

Which regimen should the DTC choose?

CEA of Two Thrombolytics in Acute MI in
Australia (6)

The study concluded that although tPA had slightly

better efficacy and saved marginally more lives,
when cost was taken into account, more patients
could be treated and more lives saved using SK.