presentation to ul's medical school on health economics
TRANSCRIPT
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Health Economics & Evidence Based Practice
Stephen Kinsella KBS
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2 Sections
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3 Ideas
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Microcosting
Screening Programmes
Simple Clinical Scores
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<1>
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Microcosting
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How Much?
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Background
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Background
McElligott, Kinsella, & Roy (2006, 2009)
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Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
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Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
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Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital
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Background
McElligott, Kinsella, & Roy (2006, 2009)
1 Patient
Birth at 24 weeks: the marginal case
212 days in hospital
Q: How much did this cost?
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Data
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Data176 variables
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Data176 variables 17 different antimicrobials,
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations2 x National Neonatal Transport Transfer
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Data176 variables 17 different antimicrobials, 479 ‘antibiotic days’ 369 ‘diuretic-days’ 95 ventilation days 86 transfusions
83 radiological procedures including 47 X-rays, 1 MRI, 35 ultrasound scans (head,
abdomen, heart)940 laboratory investigations2 x National Neonatal Transport TransferFamily’s Time, Equipment Maintenance,
Refurbishment, and more
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Day 19 Fungal Sepsis, Transfer to Crumlin
Day 202RSV Vaccination
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Total Cost
TC = €665,219.88 1 week: cost €5,167.50Fixed cost: €26,608.00
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Very precise data implies increased cost
TC, MC substantially larger than UK, US estimates.
So What? Vast Budget Implications
Conclusion
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</1>
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<2>
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Simple Clinical Scoring
Kellett et al 2006, 2007, 2008
Simple tests give predictive scores which save time, effort, money, and, maybe, lives.
Big Q: How much?
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Cost Effectiveness of Screening for Dementia
Trepel & Kinsella, 2008, Trepel’s PhD
Simple Idea, very complex implementation
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Cochrane Review on Costing Studies
What methods do people use when making ec. evaluations
What numbers do they get, and why?
A meta analysis (see poster)
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</2>
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Ching?
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
5. Private Funding opportunities also exist, please contact me directly for details.
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Ching?
1. HRB/NCI Graduate fellowships in health economics, see http://tinyurl.com/a6gbk9
2. HRB Health Research Project grants, see http://tinyurl.com/axv2hc
3. IRCHSS Post Graduate Scholarships, see http://tinyurl.com/9fqug8
4. IRCSET Post Graduate Scholarships, see http://tinyurl.com/7frgjk
5. Private Funding opportunities also exist, please contact me directly for details.
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Questions I want to askHow much?
Comparison/Evaluation of different methods
Tricky data problems
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Health Economics & Evidence Based Practice
Stephen Kinsella KBS