Provide A Very Rough Estimate, In QALY, Of The Benefit Provided By Your Health Intervention

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ECON 317 SPRING 2019 : GROUP ASSIGNMENT 4: QALY

Due March 21st, 2019, by 11:55 PM

This assignment is meant to provide a very rough estimate, in QALY, of the benefit provided by your health intervention. To find this estimate, you must interview at least five different people. Due to UVic rules relating to ethics and interviews, these people may include ONLY:

· Members of your group.

· Other CURRENT ECON 317 students. (You can ‘trade’ interviews with other groups.)

· Imaginary people (pretend you are someone else and try to answer as they would answer.)

Each person interviewed will be asked to provide quality of life information on a medical condition through a visual analogue scale, a standard gamble and a time trade-off question.

When submitting your assignment, please include:

· Copies of your visual scales, questionnaires and interview scripts (you may use the ones provided, if you wish).

· A table listing the relevant rating (visual scale measurement, standard gamble probability or time trade-off ‘B’ value) for each person interviewed. Do NOT use the real names of the persons interviewed – assign them a code name or index number to maintain their privacy.

· A table listing the QALY calculated from the above, using the techniques from Lecture 7.

· A technical appendix with your QALY calculations.

· A discussion of your results:

· Were your QALY values close together or far apart?

· Did one method (SG or TTO) provide consistently higher or lower QALY values than the other? If so, how do you explain it?

· Do you think your interviewee’s characteristics affected the QALY measures? If so, which ones, and how? (e.g. Age, Gender, Cultural Background, whether they’d experienced the health state before)

· If you were to do this assignment again, what would you change to improve the reliability of your results?

· A summary of your investigation, and what you learned from it. You should also answer the following question: based on your work in this assignment, which QALY measure do you think is the most reliable?

Steps to Performing the Assignment

1. Decide what health condition you will investigate. This should be the main condition that your health intervention treats. For example, if your health intervention helps people find safe, nutritious food, the condition could be acute food poisoning (unsafe food) or chronic malnutrition (lack of nutritious food).

You must specifiy whether your condition is a chronic (lasts forever) or temporary condition. For the math to work, it is important that this condition be preferred to being dead (there are fates worse than death!) Some examples are listed below, but you are free to choose any medical, mental, social or otherwise health-related condition that is of interest to your group.

Chronic	Temporary
Malnutrition	Food Poisoning
Opiate Addiction	Drug Overdose
Loneliness and Isolation	Lack of Language Skills
Quadruplegia	Broken Leg
Chronic Depression	Influenza

2. If you choose a temporary condition, make sure that it is worse than heartburn. You will be using heartburn (acid reflux), with a known QALY of 0.82, as your comparison condition in calculations[footnoteRef:1]. If the condition you choose is NOT worse than heartburn, some of the questions in the default questionnaires won’t give the right result. [1: This value was obtained from Heudebert, G. R. et al. (2000). What is Heartburn Worth? A Cost-Utility Analysis of Management Strategies. Journal of General Internal Medicine, 15(3), 175 – 182. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495356/ If you don’t feel heartburn is an appropriate comparison state for your condition, contact the instructor for an alternative.]

3. Write a description for your chosen condition (and for heartburn, if you chose a temporary health state). This description must be short, easy to understand, and able to convey to the people being interviewed what the condition is like. They must be able to imagine themselves suffering from the condition.

4. Prepare your questionnaires. You may modify the ones provided, or create your own. If you are interviewing people whose first language is not English, it’s fine to have your questions in another language – just be sure to provide English translations in addition to the originals when you hand in your assignment.

5. Conduct your interviews and write down data.

6. Perform the QALY calculations (similar to those in Lecture 7).

7. As a team, discuss the results and write your discussion, summary and conclusion. You can always ask the instructor for help if you need it! Either ask in class, or e-mail [email protected] .

8. Edit the report and hand it in.

MARKING RUBRIC:

(30%) DATA COLLECTION, PRESENTATION AND ORGANIZATION: All questionnaires and relevant answers are present and organized in a way that is clear and easy to understand. The privacy of the interviewees is respected, and no identifying information is present.

(30%) QALY CALCULATION AND PRESENTATION: QALY were calculated and placed in an appropriate, clear table. QALY calculations are available in a technical appendix, correct and easy to follow. Any assumptions are stated clearly. Any outside references used are cited appropriately in a bibliography.

(30%) DISCUSSION: All required discussion topics are present. The discussion is well-reasoned, logical and consistent with the data collected. No obviously strange or important feature of the data is ignored. If and when necessary, students made use of outside sources to back up their arguments. These sources are cited appropriately (APA format) in a bibliography.

(10%) SUMMARY AND CONCLUSION: Work is appropriately summarized. The question of which method of QALY estimation is most reliable is addressed logically and in a way consistent with both the data and the discussion.

APPENDIX A: VISUAL ANALOGUE SCALE SAMPLE SCRIPT AND QUESTIONNAIRE

NOTATION: Your chosen health condition is [Condition H]

INTERVIEWER: Describe [Condition H] to the interviewee, using the description you have written.

INTERVIEWER: “Do you understand the health condition?” If the answer is yes, continue below. Otherwise, clear up confusion about the health issue.

INTERVIEWER: (pointing as appropriate) “This end of the scale represents being dead. This end represents being in perfect health. Please show me where [Condition H] fits on this scale.”

SAMPLE VISUAL ANALOGUE SCALE: Since distances are very difficult to measure on the sample scale below, you might want to use a ruler with markings on one side. I suggest showing the blank side, without markings, to the interviewee, to avoid having the markings affect their choice.

DATA COLLECTION: If using a ruler, make a note of the measurements corresponding to death (QALY = 0), full health (QALY = 1) and [Condition H] as indicated by the interviewee.

If Death is at location L0, Full Health is at location L1 and [Condition H] is at location LH, then the QALY for [Condition H] can be calculated as

QALY = (LH – L0)/(L1 – L0)

APPENDIX B: STANDARD GAMBLE SAMPLE SCRIPT AND QUESTIONNAIRE

This questionnaire is lightly adapted from the one in

Benjamin Littenberg et al. (2003). Paper Standard Gamble: The Reliability of a Paper Questionnaire to Assess Utility. Medical Decision Making, 23(6), 480 – 488. Retrieved from http://mdm.sagepub.com/content/23/6/480.refs

Off-campus link:

https://journals-sagepub-com.ezproxy.library.uvic.ca/doi/abs/10.1177/0272989X03259817

NOTATION: Your chosen health condition is [Condition H]. Temporary heartburn is [Heartburn]. The duration of a temporary state is [A]. The choice of [A] is up to you: depending on the condition, 10 years, 5 years, 1 year, 6 months, 1 month or 1 week may be appropriate.

INTERVIEWER: Describe [Condition H] to the interviewee, using the description you have written. If you have chosen a temporary condition, also describe [Heartburn].

FOR A CHRONIC CONDITION:

INTERVIEWER: “You have [Condition H], which will last for the rest of your life if left untreated. There is a treatment available. If it works, it will cure you completely and permanently with no side effects. If it doesn’t work, you will die instantly. Would you take this treatment right now if you knew…

…it had a 100% chance of cure and 0% risk of death?

… it had a 99% chance of cure and 1% risk of death?

… (etc.)”

To save time, you may print out a version of this questionnaire on a sheet of paper, with 10 to 20 choices followed by the text ‘yes / no’, and ask the interviewee to circle yes or no for each choice.

Note 1: You don’t have to go in 1% steps. You can move by 5% or 10% at a time, if appropriate, and ‘zoom in’ once you find the point where the answer changes from ‘yes’ to ‘no’.

Note 2: If you find that even a 1% risk of death is too much for all of your interviewees, try treating your condition as a temporary condition with a very long duration (e.g. 60 years).

DATA COLLECTION: The chance of cure at which the interviewee is just barely willing to take the pill corresponds to ‘p’ on Slide 15 of the lecture notes for Lecture 7.

FOR A TEMPORARY CONDITION:

INTERVIEWER: “You currently suffer from [Heartburn], which is expected to last for [A]. There is a treatment available. It will instantly and completely cure you of [Heartburn], but there is a chance that you will experience [Condition H] as a side effect. This side effect would also last for [A]. Would you take this treatment right now if you knew…

…the chance of the side effect was 0%?

…the chance of the side effect was 1%?

… (etc.)”

Note 1: You don’t have to go in 1% steps. You can move by 5% or 10% at a time, if appropriate, and ‘zoom in’ once you find the point where the answer changes from ‘yes’ to ‘no’.

DATA COLLECTION: The chance of side effect at which the interviewee is just barely willing to take the pill corresponds to (1 – p) on Slide 17 of the lecture notes for Lecture 7. QALY can be calculated from this according to the methods from Individual Assignment 4.

Note 2: In this questionnaire, [Heartburn] is equivalent to Outcome H on Slide 17, and [Condition H] is equivalent to Outcome S. The reason this is ‘flipped’ is that Outcome S needs to be worse than Outcome H for the math to work – otherwise, the treatment would always be preferred, since both possible outcomes (full health or Outcome S) would be better than Outcome H.

APPENDIX C: TIME TRADE OFF SAMPLE SCRIPT AND QUESTIONNAIRE

INTERVIEWER: Describe [Condition H] to the interviewee, using the description you have written. If you have chosen a temporary condition, also describe [Heartburn].

FOR A CHRONIC CONDITION:

Refer to Slide 20 from the Lecture 7 notes. For a chronic condition, ‘A’ is taken to be expected remaining years of life. This can be calculated by subtracting the interviewee’s age from the average Canadian’s life expectancy. The average Canadian life expectancy is currently about 81 years, so for a 21-year-old interviewee, ‘A’ would be (81 – 21) = 60.

INTERVIEWER: “How old are you?” This information is needed to calculate expected remaining years of life.

INTERVIEWER: “You currently suffer from [Condition H], and if untreated it will last the rest of your life. There is a treatment available. It will completely and permanently cure you of [Condition H], but will also shorten your life. Would you take the treatment right now if you knew…

…it would shorten your life by 1 day?

…it would shorten your life by 1 year?

…if would shorten your life by 2 years?

….(etc.)”

Note 1: You don’t have to go in 1 year steps. You can move by 5 or 10 years, minutes, hours or days if appropriate, and ‘zoom in’ once you find the point where the answer changes from ‘yes’ to ‘no’. If you find you continue to run into trouble, considering treating the condition as a ‘temporary’ one with a very long duration (e.g. 60 years).

DATA COLLECTION: The maximum number of years that the interviewee is willing to sacrifice and still take the treatment corresponds to (A – B) on Slide 19 of the lecture notes for Lecture 7. As mentioned above, ‘A’ on Slide 19 is equal to (Average life expectancy – Age of interviewee).

FOR A TEMPORARY CONDITION:

INTERVIEWER: “You currently suffer from [Heartburn], and it is expected to last for [A]. There is a treatment available. It will completely cure the [Heartburn], but you will suffer [Condition H] as a temporary side effect. Would you take this treatment right now if you knew the side effect would last for…

… 1% of [A]?

… 10% of [A]?

… 20% of [A]?

…(etc.)”

Note : You can move in large steps, if appropriate, and ‘zoom in’ once you find the point where the answer changes from ‘yes’ to ‘no’.

DATA COLLECTION: The highest duration of side effects for which the interviewee is still willing to take the treatment corresponds to ‘B’ on Slide 21 of the lecture notes for Lecture 7. Heartburn is S, and [Condition H] is H.