HECN3010 Introduction to the Economic Evaluation of HealthAugust, 2023/2024100% Resit AssignmentYou are asked to investigate the most cost-effective approach to recommend for caring for patients in England aged 35 who have today begun to experience symptoms of an upper respiratory tract infection (URTI), and who would otherwise be predicted to live on average for 40 more years. Although there are many possible consequences of an URTI, assume initially that these patients will either not see any worsening of symptoms, or will progress to developing pneumonia. Patients with URTI symptoms can either be initially screened by going to an accident and emergency (A&E) department, or by calling a telephone helpline like NHS 111. You are given the following information, which has been compiled by a clinician with little background in health economics: you should note that some information may be missing, some assumptions may be dubious, and you may need to make additional plausible informed assumptions to best complete your answer.
Patients with URTI symptoms generally have an initial health-related quality of life (HRQoL) of 0.85 (i.e. a health state that would represent 0.85 QALYs if experienced for a year).If a patient attends A&E, they will be seen and diagnosed in person. If a patient calls 111, they will be given advice by telephone after being asked to describe their symptoms.Different methods of screening are associated with different costs, and with different outcomes. Based on observational data, we think the below is true:·
The condition of the vast majority (99%) of patients experiencing URTI symptoms will improve in under a week, and if untreated these patients will suffer a 0.80 unit fall in QoL for on average five days, before returning to their initial health state, and no reduction in life expectancy.·
1% of patients will however develop pneumonia within two days, which is associated with 40% mortality if untreated. It is also associated with a 1.1 fall in HRQoL for 14 days, and a reduction in quality of life of 0.1 (compared to the baseline of 0.85) thereafter if the individual survives.·
Patients who immediately call 111 will be advised to isolate at home and take paracetamol (costing 20p per day, and which the individual can buy out-of-pocket).Patients who immediately attend A&E will be admitted to hospital for monitoring for two days, if the hospital has spare capacity.·
The cost of one A&E attendance is about £400.·
Patients who are admitted to hospital cause additional costs of £400 per day.·
Patients who develop pneumonia receive additional treatment costing on average £800.Based on this, which method of screening, if any, should you recommend to patients? What do you expect the incremental cost-effectiveness ratio (ICER) associated with the use of this treatment rather than the other to be? Show all of your working and discuss any weaknesses with the information you have been given.
In answering the question, you may wish to consider:
· What is the best way to illustrate the decision being made here?
· What additional assumptions, if any, do you need to make to answer this question?
· Are any of the assumptions stated in this brief unrealistic?
· Is there anything you would propose to make your results more robust?
Please note: this is an illustrative example designed for educational purposes. It should not be taken as a representation of clinical reality, does not constitute medical advice, and should not be taken as such.
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