Evaluacioacuten econoacutemica de las

vacunas Aspectos

metodoloacutegicos

Juan M Cabaseacutes

Departamento de Economiacutea

Universidad Puacuteblica de Navarra

Madrid 27 de febrero de 2013

LA APORTACIOacuteN DE LAS VACUNAS AL

BIENESTAR SOCIAL

Evaluacioacuten econoacutemica de las vacunas

1 Evaluacioacuten econoacutemica de la prevencioacuten

2 Aspectos metodoloacutegicos de la evaluacioacuten econoacutemica

de las vacunas

3 La evaluacioacuten econoacutemica de las vacunas en Espantildea

Vaccine

Volume 31 Issue 2 2 January 2013 Pages 285ndash286

WHO position paper on hepatitis A vaccines June 2012mdash

Recommendations

WHO recommends that vaccination against HAV be integrated into

the national immunization schedule for children aged ge1 year if

indicated on the basis of incidence of acute hepatitis A change in the

endemicity from high to intermediate and consideration of cost-

effectiveness

LA APORTACIOacuteN DE LAS VACUNAS AL

BIENESTAR SOCIAL

Evaluacioacuten econoacutemica de las vacunas

1 Evaluacioacuten econoacutemica de la prevencioacuten

2 Aspectos metodoloacutegicos de la evaluacioacuten econoacutemica

de las vacunas

3 La evaluacioacuten econoacutemica de las vacunas en Espantildea

Vaccine

Volume 31 Issue 2 2 January 2013 Pages 285ndash286

WHO position paper on hepatitis A vaccines June 2012mdash

Recommendations

WHO recommends that vaccination against HAV be integrated into

the national immunization schedule for children aged ge1 year if

indicated on the basis of incidence of acute hepatitis A change in the

endemicity from high to intermediate and consideration of cost-

effectiveness

Vaccine

Volume 31 Issue 2 2 January 2013 Pages 285ndash286

WHO position paper on hepatitis A vaccines June 2012mdash

Recommendations

WHO recommends that vaccination against HAV be integrated into

the national immunization schedule for children aged ge1 year if

indicated on the basis of incidence of acute hepatitis A change in the

endemicity from high to intermediate and consideration of cost-

effectiveness

4

1- Evaluacioacuten econoacutemica de la prevencioacuten

1 Fundamentos econoacutemicos Eficiencia Utilitarismo

2 Teacutecnicas de evaluacioacuten econoacutemica

a Anaacutelisis Coste-Beneficio (ACB)

b Anaacutelisis Coste- Efectividad (ACE)

c Anaacutelisis Coste-Utilidad (ACU)

3 Evaluacioacuten econoacutemica en la praacutectica El ACE y el ACU

a Eleccioacuten de la cuestioacuten a estudiar Perspectiva del anaacutelisis

b Disentildeo Modelizacioacuten Seleccioacuten de alternativas

c Medida y valoracioacuten de costes y efectos

d Ajustes temporales El descuento

e Riesgo e incertidumbre Anaacutelisis de sensibilidad Plano Coste Efectividad Curvas de aceptabilidad

5

Anaacutelisis coste-efectividad

Anaacutelisis Coste Utilidad (ACU) Anaacutelisis coste-efectividad Resultados medidos en unidades

objetivas Output final antildeos de vida ganados o outputs

intermedios tasas de prevalencia reducidas casos evitados

hellip

Anaacutelisis coste-utilidad Resultados medidos en unidades

subjetivas antildeos de vida ajustados por calidad ganados

QALYs

Calidad de

vida

relacionada

con la salud

Salud

perfecta 10

Antildeos

Muerte 1 Muerte 2

Sin programa

Con programa

00

C1 - C0

ICER =

E1 - E0

7

2- Aspectos metodoloacutegicos de la evaluacioacuten

econoacutemica de las vacunas

1 Eleccioacuten de la cuestioacuten a estudiar Perspectiva del anaacutelisis disentildeo Modelizacioacuten Seleccioacuten de alternativas

2 Medida de la efectividad Mejoras en la salud

3 Identificacioacuten medida y valoracioacuten de costes

4 Consideracioacuten temporal de costes y efectos

5 Consideracioacuten del riesgo y la incertidumbre

6 Reglas de decisioacuten Ratios ACE y ACB (DAP) Anaacutelisis de umbral Plano CE Curvas de aceptabilidad

8

1 Eleccioacuten de la cuestioacuten a estudiar

Perspectiva del anaacutelisis

Ciudadanos gestores poliacuteticos sociedad en su conjunto

Disentildeo

Modelizacioacuten Modelos de Markov aacuterboles de decisioacuten

Estaacuteticos y dinaacutemicos

Alternativas

Ej Poblacioacuten vs grupos de riesgo edadeshellip

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

5

Anaacutelisis coste-efectividad

Anaacutelisis Coste Utilidad (ACU) Anaacutelisis coste-efectividad Resultados medidos en unidades

objetivas Output final antildeos de vida ganados o outputs

intermedios tasas de prevalencia reducidas casos evitados

hellip

Anaacutelisis coste-utilidad Resultados medidos en unidades

subjetivas antildeos de vida ajustados por calidad ganados

QALYs

Calidad de

vida

relacionada

con la salud

Salud

perfecta 10

Antildeos

Muerte 1 Muerte 2

Sin programa

Con programa

00

C1 - C0

ICER =

E1 - E0

7

2- Aspectos metodoloacutegicos de la evaluacioacuten

econoacutemica de las vacunas

1 Eleccioacuten de la cuestioacuten a estudiar Perspectiva del anaacutelisis disentildeo Modelizacioacuten Seleccioacuten de alternativas

2 Medida de la efectividad Mejoras en la salud

3 Identificacioacuten medida y valoracioacuten de costes

4 Consideracioacuten temporal de costes y efectos

5 Consideracioacuten del riesgo y la incertidumbre

6 Reglas de decisioacuten Ratios ACE y ACB (DAP) Anaacutelisis de umbral Plano CE Curvas de aceptabilidad

8

1 Eleccioacuten de la cuestioacuten a estudiar

Perspectiva del anaacutelisis

Ciudadanos gestores poliacuteticos sociedad en su conjunto

Disentildeo

Modelizacioacuten Modelos de Markov aacuterboles de decisioacuten

Estaacuteticos y dinaacutemicos

Alternativas

Ej Poblacioacuten vs grupos de riesgo edadeshellip

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

Anaacutelisis Coste Utilidad (ACU) Anaacutelisis coste-efectividad Resultados medidos en unidades

objetivas Output final antildeos de vida ganados o outputs

intermedios tasas de prevalencia reducidas casos evitados

hellip

Anaacutelisis coste-utilidad Resultados medidos en unidades

subjetivas antildeos de vida ajustados por calidad ganados

QALYs

Calidad de

vida

relacionada

con la salud

Salud

perfecta 10

Antildeos

Muerte 1 Muerte 2

Sin programa

Con programa

00

C1 - C0

ICER =

E1 - E0

7

2- Aspectos metodoloacutegicos de la evaluacioacuten

econoacutemica de las vacunas

1 Eleccioacuten de la cuestioacuten a estudiar Perspectiva del anaacutelisis disentildeo Modelizacioacuten Seleccioacuten de alternativas

2 Medida de la efectividad Mejoras en la salud

3 Identificacioacuten medida y valoracioacuten de costes

4 Consideracioacuten temporal de costes y efectos

5 Consideracioacuten del riesgo y la incertidumbre

6 Reglas de decisioacuten Ratios ACE y ACB (DAP) Anaacutelisis de umbral Plano CE Curvas de aceptabilidad

8

1 Eleccioacuten de la cuestioacuten a estudiar

Perspectiva del anaacutelisis

Ciudadanos gestores poliacuteticos sociedad en su conjunto

Disentildeo

Modelizacioacuten Modelos de Markov aacuterboles de decisioacuten

Estaacuteticos y dinaacutemicos

Alternativas

Ej Poblacioacuten vs grupos de riesgo edadeshellip

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

7

2- Aspectos metodoloacutegicos de la evaluacioacuten

econoacutemica de las vacunas

1 Eleccioacuten de la cuestioacuten a estudiar Perspectiva del anaacutelisis disentildeo Modelizacioacuten Seleccioacuten de alternativas

2 Medida de la efectividad Mejoras en la salud

3 Identificacioacuten medida y valoracioacuten de costes

4 Consideracioacuten temporal de costes y efectos

5 Consideracioacuten del riesgo y la incertidumbre

6 Reglas de decisioacuten Ratios ACE y ACB (DAP) Anaacutelisis de umbral Plano CE Curvas de aceptabilidad

8

1 Eleccioacuten de la cuestioacuten a estudiar

Perspectiva del anaacutelisis

Ciudadanos gestores poliacuteticos sociedad en su conjunto

Disentildeo

Modelizacioacuten Modelos de Markov aacuterboles de decisioacuten

Estaacuteticos y dinaacutemicos

Alternativas

Ej Poblacioacuten vs grupos de riesgo edadeshellip

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

8

1 Eleccioacuten de la cuestioacuten a estudiar

Perspectiva del anaacutelisis

Ciudadanos gestores poliacuteticos sociedad en su conjunto

Disentildeo

Modelizacioacuten Modelos de Markov aacuterboles de decisioacuten

Estaacuteticos y dinaacutemicos

Alternativas

Ej Poblacioacuten vs grupos de riesgo edadeshellip

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

Perspectiva

Salleras L Navas E Torner N Prat

AA Garrido P Soldevila N

Domiacutenguez A

Economic benefits of inactivated

influenza vaccines in the

prevention of seasonal influenza in

children

Hum Vaccin Immunother 2013 Jan

79(3) [Epub ahead of print]

Review published studies the

influenza-inactivated vaccine in 10

studies and the virosomal inactivated

vaccine in 3 studies

The results yearly vaccination of

children with the inactivated

influenza vaccine saves money

from the societal and family

perspectives but not from the

public or private provider

perspective When vaccination does

not save money the cost-

effectiveness ratios were very

acceptable It can be concluded that

inactivated influenza vaccination of

children is a very efficient

intervention

14

Modelizacioacuten de Markov

Ejemplo Neumococo

6 estados de salud posibles

sano meningitis bacteremia neumoniacutea otitis media y muerte

15

Modelos de Markov

Ejemplo Vacunacioacuten del Neumococo

Modelos

Modelos estaacuteticos No consideran la reduccioacuten en la fuerza de la infeccioacuten consecuencia de la vacunacioacuten

Modelos dinaacutemicos Contemplan la reduccioacuten de los susceptibles y de la fuerza de la infeccioacuten

Inmunidad de grupo (herd)

Externalidad positiva

Highlights

The economics of vaccinate pre-school age children andor school age children was

assessed Vaccinating 2ndash18 year olds was estimated to be the most cost-effective

policy The mean ICER for this policy was estimated at pound251QALY relative to

current practice Paediatric vaccination would appear to be a highly cost-

effective intervention

Modelo dinaacutemico

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

15

Modelos de Markov

Ejemplo Vacunacioacuten del Neumococo

Modelos

Modelos estaacuteticos No consideran la reduccioacuten en la fuerza de la infeccioacuten consecuencia de la vacunacioacuten

Modelos dinaacutemicos Contemplan la reduccioacuten de los susceptibles y de la fuerza de la infeccioacuten

Inmunidad de grupo (herd)

Externalidad positiva

Highlights

The economics of vaccinate pre-school age children andor school age children was

assessed Vaccinating 2ndash18 year olds was estimated to be the most cost-effective

policy The mean ICER for this policy was estimated at pound251QALY relative to

current practice Paediatric vaccination would appear to be a highly cost-

effective intervention

Modelo dinaacutemico

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Modelos

Modelos estaacuteticos No consideran la reduccioacuten en la fuerza de la infeccioacuten consecuencia de la vacunacioacuten

Modelos dinaacutemicos Contemplan la reduccioacuten de los susceptibles y de la fuerza de la infeccioacuten

Inmunidad de grupo (herd)

Externalidad positiva

Highlights

The economics of vaccinate pre-school age children andor school age children was

assessed Vaccinating 2ndash18 year olds was estimated to be the most cost-effective

policy The mean ICER for this policy was estimated at pound251QALY relative to

current practice Paediatric vaccination would appear to be a highly cost-

effective intervention

Modelo dinaacutemico

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Highlights

The economics of vaccinate pre-school age children andor school age children was

assessed Vaccinating 2ndash18 year olds was estimated to be the most cost-effective

policy The mean ICER for this policy was estimated at pound251QALY relative to

current practice Paediatric vaccination would appear to be a highly cost-

effective intervention

Modelo dinaacutemico

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Modelo dinaacutemico

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Externalidades positivas de la vacunacioacuten

Respuestas Subvencioacuten o provisioacuten puacuteblica

Vacunaciones

euro

BM privado

CM

BM para terceros

BM Social

V V1

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Medida de la efectividad Mejoras en la salud

Utilidad de la anticipacioacuten hasta la fecha de la infeccioacuten evitada

Es funcioacuten de la ansiedad asociada al riesgo de infeccioacuten y a la efectividad percibida de la vacunacioacuten

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

T0

Vacunacioacuten

T2 Final T1 Infeccioacuten

Utilidad

Utilidad de anticipacioacuten

(Cohen and Henderson 1988)

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

23

Reglas de decisioacuten Ratios ACE

Reglas de decisioacuten

Ratios ACE (ICER)

Anaacutelisis de umbral

Plano CE

C1 - C0

ICER =

E1 - E0

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

24

Reglas de decisioacuten Plano CE

∆C

∆E

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

25

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Juan M Cabaseacutes y Eduardo Saacutenchez

Universidad Puacuteblica de Navarra

26

∆C

∆E

Reglas de decisioacuten Plano CE

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Juan M Cabaseacutes

Universidad Puacuteblica de Navarra

27

Plano coste-efectividad e incertidumbre

CEAC para EVAscore

00

01

02

03

04

05

06

07

08

09

10

0 euro 500 euro 1000 euro 1500 euro 2000 euro

Disponibilidad a pagar ante un incremento de EVAscore (K)

Pro

ba

bilid

ad

(B

en

efi

cio

Ne

to In

cre

me

nta

l gt

0)

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

3- Evaluacioacuten econoacutemica de vacunas en

Espantildea

Aspectos metodoloacutegicos

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Garciacutea-Alteacutes A

Systematic review of economic evaluation studies Are

vaccination programs efficient in Spain

Vaccine 2013 Jan 29 pii S0264-410X(13)00086-8 doi

101016jvaccine201301029 [Epub ahead of print]

A total of 46 studies met inclusion criteria The topics studied

were pneumococcal vaccination influenza vaccination

Hepatitis B vaccination and varicella vaccination

Cost-minimization analysis perspective of society long

time horizon use of modeling techniques and the

inclusion of direct and indirect costs were the most

common methodological characteristics The results of the

studies reviewed showed in most cases net savings or cost-

effectiveness ratios below euro30000QALY

Economic evaluation methods should be applied more

rigorously

Evaluacioacuten econoacutemica de vacunas en Espantildea

Supuesto

Sin unas bases de datos de costes y de efectividad (utilidad) creiacutebles y aceptadas cualquier propuesta metodoloacutegica resulta insuficiente en la praacutectica y se desacredita ante los decisores

Esta pudiera ser una razoacuten para el escaso desarrollo de la evaluacioacuten econoacutemica de tecnologiacuteas sanitarias en Espantildea

Propuesta

Desarrollar una cultura de evaluacioacuten econoacutemica

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los logros parciales

Datos disponibles para ACE y ACU

Costes unitarios

Bases de datos de costes unitarios SOIKOS OBLIKUE etc

Metodologiacuteas de estimacioacuten de costes ABC cuidados informales

Efectividad

AVACs (QALYs) Valores de los estados de salud del EQ-5D para

Espantildea con TTO y VAS (Badiacutea 1999)

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los retos

Desarrollar bases de datos de costes unitarios generalmente

aceptadas

Desarrollar un conjunto de valores de los estados de salud

actualizado uacutetil para obtener AVACs (QALYs)

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los costes unitarios

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en Espantildea Las

medidas de efectividad

DOacuteNDE ESTAacute QALY

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los logros parciales

Datos disponibles para ACE y ACU

Costes unitarios

Bases de datos de costes unitarios SOIKOS OBLIKUE etc

Metodologiacuteas de estimacioacuten de costes ABC cuidados informales

Efectividad

AVACs (QALYs) Valores de los estados de salud del EQ-5D para

Espantildea con TTO y VAS (Badiacutea 1999)

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los retos

Desarrollar bases de datos de costes unitarios generalmente

aceptadas

Desarrollar un conjunto de valores de los estados de salud

actualizado uacutetil para obtener AVACs (QALYs)

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los costes unitarios

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en Espantildea Las

medidas de efectividad

DOacuteNDE ESTAacute QALY

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los retos

Desarrollar bases de datos de costes unitarios generalmente

aceptadas

Desarrollar un conjunto de valores de los estados de salud

actualizado uacutetil para obtener AVACs (QALYs)

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los costes unitarios

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en Espantildea Las

medidas de efectividad

DOacuteNDE ESTAacute QALY

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en

Espantildea Los costes unitarios

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en Espantildea Las

medidas de efectividad

DOacuteNDE ESTAacute QALY

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Evaluacioacuten econoacutemica de Tecnologiacuteas Sanitarias en Espantildea Las

medidas de efectividad

DOacuteNDE ESTAacute QALY

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Juan M Cabaseacutes

Departamento de Economiacutea

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

EQ-5D-5L valuation project for the Spanish population ndash a descriptive overview

and preliminary results

Ramos-Gontildei JM 12 M Errea3 O Rivero-Arias24JL Pinto-Prades5 JM Cabaseacutes3

EuroQol Plenary meeting Rotterdam (September 2012)

1 HTA Unit of Canary Island Health Care Service (FUNCIS)

2 REDISSEC

3 Universidad Puacuteblica de Navarra

4 University of Oxford

5 Universidad Pablo Olavide

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

Juan M Cabaseacutes

Departamento de Economiacutea

42

Muchas gracias

jmcabasesunavarraes

42

Muchas gracias

jmcabasesunavarraes