| Discussion
In
our fictional scenario, by switching from our current care to our
new drug, we will have done the following:
- Significantly
reduced quality of care. We will now prevent roughly 80 hip fractures
compared to roughly 138 prevented with current treatment in a
course of 14.5 years.
- Significantly
increased our expenses. We will now have spent $3.6MM less in
prevention treatment, but will have significant new expenses due
to the increase in hip fractures.
This
examples shows several things:
- You
can do a simple, yet powerful "back-of-the-envelope"
analysis using a spreadsheet tool.
- You
need to look at prevalence data in your population, consider what
you are currently doing, assess the evidence and then do sensitivity
analyses to explore potential impacts of practice change.
- Flowing
evidence into your cost analysis is highly important and revealing.
In this instance we see that even though a new drug may be less
expense per year of treatment, we are actually significantly reducing
our quality of care AND increasing our expenses by making a switch.
To
compute a cost per benefit, which you can then use for comparison
purposes:
Quick
Equation #1: NNT x study period x dollars per time unit
OR #2: NNT x study period cost
- Many
times people talk about NNT without including the appropriate
associated time period. We see by this example, that it is this
difference in time periods between the old agent and the new that
has made the significant difference.
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| Fictional
Scenario
Lifetime risk of hip fracture in women is 15% with significant mortality
(20-30% of women die in the first year following hip fracture).
HRT is now found to have many risks. Other fracture prevention drugs
have risks. There is a new (fictional) drug on the market that has
fewer risks and that many docs are starting to use on high and moderate
risk women. The drug is getting a lot of press attention and has
good evidence behind it.
Many women in your organization are requesting information and treatment
for prevention of fractures. Many are asking about this new drug.
One year of treatment is cheaper than alendronate.
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