The focus of this chapter has been on estimating treatment-related costs. The changes in treatment-related costs for administration, diagnosis, monitoring, and side effects are estimated based on estimated changes in the use of a variety of health-care resources, including provider time and supplies for administration, pro- vider and laboratory personnel time and supplies for diagnosis and monitoring drug safety and efficacy, and the full range of health-care services needed for the treat- ment of any drug-related side effects. Treatment-related changes in the use of these resources over the budget impact analysis time horizon can be calculated in addition to their use in estimating the treatment-related costs. They can be presented to bud- get holders to help them with planning their resource needs (see Chap. 11).
Exercises
Exercise 5.1 Identify a new drug that is about to come to market. With which treatments will this drug compete? List the treatment-related costs associated with this new drug and its competitor treatments. Build an Excel-based workbook to calculate treatment-related costs for this new drug.
Exercise 5.2 Identify a drug that requires the use of a diagnostic test prior to prescribing the drug. List the specific costs associated with the drug and diagnostic to be included in the budget-impact analysis. Describe how these costs would be applied within the analysis. How will you estimate these costs?
Exercise 5.3 How might the sensitivity or specificity of a diagnostic test affect the estimation of treatment-related costs?
T.-H. Brodtkorb et al.
Exercise 5.4 Oncology drugs are associated with numerous side effects.
Clinical trials for oncology drugs will track side effects of grade 1 (mild) to grade 4 (most severe). In building a budget-impact analysis for a new oncology drug, how would you approach incorporating side effects such that the number of side effects considered is not unwieldly?
Exercise 5.5 Discuss characteristics of a health plan that might affect the esti- mation of treatment-related costs.
Exercise 5.6 A new inhaled corticosteroid is being approved for treatment of asthma and chronic obstructive pulmonary disease. A health plan is interested in understanding the impact that introducing this new treatment will have on its bud- gets. Discuss how this new inhaled corticosteroid will affect treatment-related costs.
Exercise 5.7 A new drug is being studied for treatment of HIV/AIDS. This drug will be used as an add-on to other commonly used drugs to make up new drug regimens. Discuss what treatment-related costs should be considered in a budget- impact analysis for this new drug.
Exercise 5.8 The introduction of a new drug comes with a substantial increase in treatment-related costs (i.e., high acquisition costs, increase in administration costs, increased monitoring and diagnostic costs). However, the drug has shown to be highly effective in preventing disease X. Even though the treatment-related costs are high, explain how introducing this drug to a health plan formulary may be beneficial.
Exercise 5.9 A budget-impact analysis is being built to examine annual bud- gets up to 5 years. Treatment-related costs are variable over a period of 1.5 years and then are constant thereafter. Explain how these costs may be accounted for within the budget-impact analysis.
Exercise 5.10 A new drug is expected to come to market for treating high cho- lesterol. Identify the reimbursement-eligible population, the treatments with which this new drug will compete, and the treatment-related costs. Build a worksheet in Excel to present this information.
References
British National Formulary. London: Pharmaceutical Press; 2015. http://www.medicinescomplete.
com/. Accessed 21 July 2015.
Ingenix, Inc. The essential RBRVS (2015): a comprehensive listing of RBRVS values for CPT and HCPCS codes. St. Anthony Publishing; 2015.
Kaiser Family Foundation and Health Research & Educational Trust. 2015 employer health ben- efits survey. http://kff.org/health-costs/report/2015-employer-health-benefits-survey/. Accessed 6 May 2016.
Linaclotide prescribing information. 2016. http://www.allergan.com/assets/pdf/linzess_pi.
Accessed 1 Aug 2016.
Lubiprostone prescribing information. 2013. http://general.takedapharm.com/content/file.
aspx?applicationcode=090cf53b-f8ae-4cce-8fcb-a8d4cad9797c&filetypecode=amitizapi&cac heRandomizer=e6a5b3dc-f519-447a-bb9f-86946d43cba8. Accessed 29 Apr 2016.
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Micromedex Healthcare Series [Internet database]. Greenwood Village: Thomson Healthcare;
2015. Accessed 21 July 2015.
Movantik (naloxegol) prescribing information. 2015. http://www.azpicentral.com/movantik/mov- antik.pdf. Accessed 29 Apr 2016.
Ontario Drug Benefit (ODB) Program E-formulary. Ontario Ministry of Health and Long-Term Care; 2015. http://www.health.gov.on.ca/en/pro/programs/drugs/odbf_eformulary.aspx.
Accessed 21 July 2015.
Statenslegemiddelverk.Legemiddelsửk. 2015. Available at: https://www.legemiddelsok.no/.
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© Springer International Publishing AG 2017
J. Mauskopf et al., Budget-Impact Analysis of Health Care Interventions, DOI 10.1007/978-3-319-50482-7_6
Estimating Condition-Related Costs
Sorrel Wolowacz, Josephine Mauskopf, and Stephanie Earnshaw
Abstract In this chapter, we discuss how to estimate any changes in condition- related costs and outcomes that might be expected to occur as a result of the intro- duction of the new drug to the formulary. These changes should be included in the budget-impact estimates if they are likely to occur within the analysis time horizon and if there are credible clinical data that indicate that such changes are likely.
Condition-related costs and outcomes that occur beyond the analysis time horizon may also be important to consider within an analysis. Consideration of these costs along with condition-related costs and outcomes that might occur for an incident versus a prevalent population are discussed.
Keywords Budget-impact analysis • Condition-related costs • Acute conditions • Chronic conditions
Chapter Goal
To provide guidance on when to include these costs in a budget-impact analy- sis. To show how to estimate from a population perspective changes in condi- tion-related costs as well as changes in health and health care service use as a result of the new drug being included in the treatment mix.
S. Wolowacz (*) • J. Mauskopf • S. Earnshaw
RTI Health Solutions, RTI International, Manchester, UK e-mail: swolowacz@rti.org
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