(Geestelijke) gezondheidszorg door een gezondheidseconomische bril
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1 (Geestelijke) gezondheidszorg door een gezondheidseconomische bril Lieven Annemans Universiteit Gent, VUB Mei 2013 Outline The problems and goals of health care systems The solution: cost-effectiveness What about interventions in psychiatry? Problems (again) Discussion 2 PC Sint-Jan-Baptist - Academische zitting 1
2 What s the problem for our health systems? 1. Health expenditure has been growing faster than the economy 2. Too much unnecessary and inadequate care 3. Undertreatment and waiting lists 4. Lack of coordination between health professionals 5. Inequities in access to care source: OECD De gevolgen van de crisis 7,0% Average OECD public health expenditure growth rates in real terms, 2000 to ,0% 5,0% 4,0% 3,0% 2,0% 1,0% 0,0% Source: OECD Health Data PC Sint-Jan-Baptist - Academische zitting 2
3 BUT let s not forget the goal of health care systems Primary goal of health care policy = to maximize the health of the population within the limits of the available resources,and within an ethical framework built on equity and solidarity principles. Report of the Belgian EU Presidency, adopted by the EU Council of Ministers of Health in Dec Health is a value in itself. It is also a precondition for economic prosperity. People s health influences economic outcomes in terms of productivity, labour supply, human capital and public spending. PC Sint-Jan-Baptist - Academische zitting 3
4 The three key values of health policy QUALITY SUSTAINABILITY SOLIDARITY 7 What does it mean for (new) treatments? We need to stimulateand make availablethose treatments that offer an added therapeutic benefit at an acceptable cost (are cost-effective), and fill unmet medical needs - OECD Report of the Belgian EU Presidency, adopted by the EU Council of Ministers of Health in Dec PC Sint-Jan-Baptist - Academische zitting 4
5 Cost-effectiveness Cost Bad intervention Current care Good Very Good (dominant) Health effect (QALY) 9 QALY: quality adjusted life years INDEX ( utility level ) Perfect health Death TIME 10 PC Sint-Jan-Baptist - Academische zitting 5
6 Voorbeeld in depressie Utility scores by disease severity over time 0.9 Disease severity 0.8 Mild Health utility Moderate Severe Visits Sobocki P, et al. Value Health Mar-Apr;10(2): PROBLEEM: waar ligt de grens? HISTORICAL BENCHMARK 50,000 per QALY: = cost effectiveness of caring for a dialysis patient (+/-4 QALYs gained for an investment of +/-200,000 ) Desaigues et al (2007): willingness to pay method 40,000 for a Healthy Life Year (for EU25) WHO (2003): 1 x GDP per capita (e.g. Belgium = +/ ) 12 PC Sint-Jan-Baptist - Academische zitting 6
7 Examples Behandeling of andere interventie Vaccinatie van ouderen tegen griep Cost per QALY gained (+/-) ( ) dominant Rookstopprogramma s 3000 Cholesterolverlagers in secundaire preventie 6000 Screenen voor dikkedarm kanker met ifobt (+/- 50-+/- 70j) 7000 Prezista in HIV/AIDS Totale Heupprothese Velcade in multiple myeloma Tysabri in multiple sclerose Nierdialyse Jaarlijkse mammografie bij vrouwen jaar EKG voor alle mannen van 40 jaar oud Jaarlijkse CT scan bij ex rokers Outline The problems and goals of health care systems The solution: cost-effectiveness What about interventions in psychiatry? Problems (again) Discussion 14 PC Sint-Jan-Baptist - Academische zitting 7
8 Example: assertive community treatment in patients with schizophrenia dominant QALY: 0.1 gain (p = 0.001) Karow et al, J Clin Psychiatry Example 2: Depression: combination (psycho + pharma) vs pharma alone Simon et al, Br J Psych, PC Sint-Jan-Baptist - Academische zitting 8
9 Results (15 months) Simon et al, Br J Psych, Outline The problems and goals of health care systems The solution: cost-effectiveness What about interventions in psychiatry? Problems (again) Discussion 18 PC Sint-Jan-Baptist - Academische zitting 9
10 Problem 1: Typical characteristics of the health care system Uncertainty Health insurance Moral hazard, adverse selection Asymmetric information Possibility of supplier-induced demand! Externalities Societal values > individual values Need for a strong, performant and flexible government 19 Is mental health care different from other care? Schizophrenia is just like cancer Rubenstein Wat bedoelde hij? 20 PC Sint-Jan-Baptist - Academische zitting 10
11 The market for mental health care IS different Moral Hazard and Adverse selection apply with particular force Asymmetry of information: applies with particular force (in some mental illnesses) More externalities: e.g. crime, violence, Larger role for government 21 Problem 2: the financing system Increasing focus on saving own money 22 PC Sint-Jan-Baptist - Academische zitting 11
12 2 questions: who gains more money? Admission for schizophrenia Setting A: no re-admission within 1 month Setting B: re-admission within 1 month Admission of alzheimer s patient Setting A: no nosocomial infection Setting B: nosocomial infection 23 More Pay for Quality the systematic and deliberate use of payment incentives that recognize and reward high levels of quality and quality improvement. (The Institute of Medicine, 2007) Explicit link between quality achievement and payment BUT: What is quality? Do we have the data? What types of incentives to provide? What about the confounders?.. (Annemans et al. KCE report 2010) 24 PC Sint-Jan-Baptist - Academische zitting 12
13 Sometimes fantastic results! 25 Sometimes less 26 PC Sint-Jan-Baptist - Academische zitting 13
14 Problem 3: A QALY is not a QALY INDEX ( utility level ) Product X Disease 1? Product Y Disease 2 27 The importance of medical need. Cfr. Social reference point (Scitovsky) Health status maximal minimal Striving above SRP Pleasure seeking Not necessary No funding Striving towards SRP Necessity depends on severity Accept higher cost/qaly in worst conditions Societal reference point -Age - Socio-economic - QALY history 28 PC Sint-Jan-Baptist - Academische zitting 14
15 Problem 4: Uncertainty: potential value The typical Dilemma Give us more evidence that your approach is value for money PAYER YOU But we will only be able to provide evidence in the real-life Give us first reimbursement Example: healthy nutrition and physical activity in inhabitants of sheltered houses DSM-IV diagnose (in %) Dr. Nick Verhaeghe UGent , ,1 28,9 22,7 15,5 16,9 14,9 13,3 5,7 10,8 I-groep C-groep I-groep: interventiegroep; C-groep: controlegroep 30 PC Sint-Jan-Baptist - Academische zitting 15
16 Karakteristieken Variabele Interventiegroep (n=201) Controlegroep (n=83) Gewicht (kg), gemiddeld BMI (kg/m²), gemiddeld Buikomtrek (cm), gemiddeld man 102 cm, n (%) vrouw 88 cm, n (%) (63.9) 70 (85.4) (52.7) 25 (89.3) Vetpercentage, gemiddeld BMIcategorie, n (%) ondergewicht normaal gewicht overgewicht obesitas 3 (1.5) 36 (17.9) 66 (32.8) 96 (47.8) 0 (0) 16 (19.3) 29 (34.9) 38 (45.8) 31 Relative risk of having CHD, stroke, diabetes and colon cancer in individuals with mental disorders Disease Age (years) Relative risk coronary heart disease stroke diabetes 1.77 colon cancer PC Sint-Jan-Baptist - Academische zitting 16
17 Resultaten: effect op BMI (kg/m²) -0,2-0,1 0 0,1 0,2 0,3 0,4-0,12 T1-T0 0,08 interventiegroep (n=201) controlegroep (n=83) T2-T0 0,11 0,35 (p = 0.04) 33 Effect of BMI decrease(if maintained) Health state Relative risk reduction if 1 kg/m² BMI decrease (%) Risk reductions in study (%) men women men women CHD Stroke Diabetes Colon cancer PC Sint-Jan-Baptist - Academische zitting 17
18 Mannen Resultaten kosteneffectiviteit (projectie over 20 jaar) ICER ( /QALY) Base case Scenario Scenario Scenario Scenario 1: full compliance Scenario 2: programma 2x/jaar Scenario 3: toename kwaliteit van leven t.g.v. daling BMI 35 More Performance based agreements? Performance Based agreements = formal agreements where the reimbursement of a treatment is related to the future performance of the treatment in in a real life situation. 36 PC Sint-Jan-Baptist - Academische zitting 18
19 Discussion Health economics is always about 2 dimensions: costs and health effects To achieve our health care goals we need to embrace health economic principles Avoid waste or less cost-effective care to reinvest in more quality, innovation and prevention Only when financial incentives encourage costeffective care they are acceptable BUT: issues of uncertainty, ethical aspects,. Mental health workers need to get engaged! 37 De toekomst ziet er zeer goed uit Voor gezondheidseconomen PC Sint-Jan-Baptist - Academische zitting 19
20 Derde druk Verkrijgbaar in elke boekhandel 39 PC Sint-Jan-Baptist - Academische zitting 20
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