How to measure health benefits?

Within healthcare, there is continuous innovation. New technologies are made available and (partly) replace existing resources or care. But how can you measure the financial value of innovation? It is not because a diagnostic device has 10 x sharper imaging that also a ten-fold health gain will be achieved, let alone that the innovation in question is 10 x more expensive than the current standard of care.

Everything starts with measuring the effect within your target group. For each innovation you have to determine what needs to be measured. Ideally, this is the so-called health gain. Certain health gains can be measured objectively (e.g., less surgery), others subjectively (e.g., less pain). Making available the aforementioned diagnostic device, for example,  could lead to a more correct diagnosis at an earlier stage of the disease, after which targeted treatment can be conducted, resulting in a higher chance of survival of patients. In this example, the average extra lifespan for the entire treated target group could thus be the health benefit to measure.

An economic value can be attributed to one life year in full health. As a consequence, a budget can then be calculated for the additional investments that must be made to obtain one additional life year within the entire treated target group. If this investment is lower than the economic value of one life year, then this definitely is worth investing. But there are many aspects that you need to consider. For medical equipment, e.g., you must of course take into account the employability (potential and duration). And health gains can possibly be gained over several years. In this example, you would be able to calculate how many patients you would have to screen to recover the investment in the new imaging device. Or to put it another way: how much budget you can ultimately save the government thanks to the use of the innovation.

However, not all health benefits can be expressed in extra life years. Let’s focus, for example, on a cancer patient who is being treated with a drug that as a side-effect induces vomiting tendencies for several hours after ingestion. This obviously has an impact on the patient’s quality of life. If you can reduce these vomiting tendencies with the help of an antiemetic, the average quality of life over this short period of several hours will have improved. The bottom line is that you have to quantify how much quality of life has been gained when additionally taking an antiemetic compared to with only taking the drug and no antiemetic (the ‘standard of care’ in this example).

And there are tools to quantify the subjective quality of life. It can be measured using standardised questionnaires. Patients participating in clinical trials are regularly surveyed using several different types of  questionnaires. The EQ-5D questionnaire is frequently used. It questions 5 dimensions (5D): mobility, self-care, daily activities, pain/discomfort and anxiety/depression. The patient can give a score for every dimension (per question). After processing, the scores are aggregated into 1 core value: utility. A healthy person has a utility of 1, a deceased person is attributed a utility of 0. The fact that you are reading this text suggests to us that your utility is somewhere between 1 and 0. Throughout your life, your utility will evolve according to the 5 dimensions and mostly decrease as you age. During your life, your utility may be temporarily lower due to e.g. a clinical event.

Sometimes you will need to benchmark your innovation against a comparator in an indirect way. It may be that for the comparator the quality of life was measured using another questionnaire (e.g., the SF-36 questionnaire). In order to be able to compare both results, you must first ‘convert’ the results in order to make them comparable. Of course, you should be alert to the fact that both studies may not be optimally comparable (e.g., the average age of patients in both study populations may be different). This can be partially solved with the help of biostatistics. However, this is a topic for another blog post.

Health economics uses these ‘measuring instruments’ to measure the delta in health gains (expressed in life years or quality of life). After that, it can be determined which budget should be invested per full unit, and a price incentive can be calculated for which the costs are balanced with the health benefits.

Are you bent on your own utility? Let us know and we will send you a tool that will allow you to calculate your own utility.

Contact

See you soon,

Your HEBIAS team.