Research in Progress: "Whose QALYs Count in Cost-Effectiveness Analyses? How Interventions That Affect Fertility and Childbearing are Evaluated"
All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.
Abstract:
Current guidelines for economic evaluations of health interventions (cost-effectiveness or cost-benefit analyses) define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on how to count health impacts of interventions that affect current and future fertility and childbearing. We sought to characterize current practices for counting such health outcomes. To do so, we developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing. We identified interventions that span the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. This review of 108 economic evaluations led to striking insights about choices analysts make in the absence of clear guidance about how to include such QALYs. We will discuss these insights and their implications as well as the rationales on which they are based. In brief, economic evaluations inconsistently consider QALYs from current pregnancies and future fertility in ways that frequently appear biased. Given this, we believe that further guidance should be given by bodies like the Panel on Cost-Effectiveness in Health and Medicine to help to standardize practice and reporting in this important area.
CHP/PCOR Conference Room
117 Encina Commons, Room 119
Stanford, CA 94305
Jeremy Goldhaber-Fiebert
Encina Commons, Room 220
615 Crothers Way
Stanford, CA 94305-6006
Jeremy Goldhaber-Fiebert, PhD, is a Professor of Health Policy, a Core Faculty Member at the Center for Health Policy and the Department of Health Policy, and a Faculty Affiliate of the Stanford Center on Longevity and Stanford Center for International Development. His research focuses on complex policy decisions surrounding the prevention and management of increasingly common, chronic diseases and the life course impact of exposure to their risk factors. In the context of both developing and developed countries including the US, India, China, and South Africa, he has examined chronic conditions including type 2 diabetes and cardiovascular diseases, human papillomavirus and cervical cancer, tuberculosis, and hepatitis C and on risk factors including smoking, physical activity, obesity, malnutrition, and other diseases themselves. He combines simulation modeling methods and cost-effectiveness analyses with econometric approaches and behavioral economic studies to address these issues. Dr. Goldhaber-Fiebert graduated magna cum laude from Harvard College in 1997, with an A.B. in the History and Literature of America. After working as a software engineer and consultant, he conducted a year-long public health research program in Costa Rica with his wife in 2001. Winner of the Lee B. Lusted Prize for Outstanding Student Research from the Society for Medical Decision Making in 2006 and in 2008, he completed his PhD in Health Policy concentrating in Decision Science at Harvard University in 2008. He was elected as a Trustee of the Society for Medical Decision Making in 2011.
Past and current research topics:
- Type 2 diabetes and cardiovascular risk factors: Randomized and observational studies in Costa Rica examining the impact of community-based lifestyle interventions and the relationship of gender, risk factors, and care utilization.
- Cervical cancer: Model-based cost-effectiveness analyses and costing methods studies that examine policy issues relating to cervical cancer screening and human papillomavirus vaccination in countries including the United States, Brazil, India, Kenya, Peru, South Africa, Tanzania, and Thailand.
- Measles, haemophilus influenzae type b, and other childhood infectious diseases: Longitudinal regression analyses of country-level data from middle and upper income countries that examine the link between vaccination, sustained reductions in mortality, and evidence of herd immunity.
- Patient adherence: Studies in both developing and developed countries of the costs and effectiveness of measures to increase successful adherence. Adherence to cervical cancer screening as well as to disease management programs targeting depression and obesity is examined from both a decision-analytic and a behavioral economics perspective.
- Simulation modeling methods: Research examining model calibration and validation, the appropriate representation of uncertainty in projected outcomes, the use of models to examine plausible counterfactuals at the biological and epidemiological level, and the reflection of population and spatial heterogeneity.
Margaret L. Brandeau
Department of Management Science and Engineering
Stanford University
Huang Building, #262
Stanford, CA 94305-4026
Margaret Brandeau is the Coleman F. Fung Professor in the School of Engineering at Stanford and a Professor of Medicine (by courtesy) at the Stanford University School of Medicine. Her research focuses on the development of applied mathematical and economic models to support health policy decisions.
She has published cost-effectiveness analyses of a variety of HIV and drug-abuse interventions including methadone maintenance, buprenorphine maintenance, HIV testing and counseling programs targeted to women of childbearing age, and HIV pre-exposure prophylaxis for key populations. She has also published a number of studies on effective allocation of HIV prevention resources. In addition, she co-edited the books Operations Research and Health Care: A Handbook of Methods and Applications (with Francois Sainfort and William Pierskalla, Kluwer Publishers, 2004) and Modeling the AIDS Epidemic: Planning, Policy, and Prediction (with Edward Kaplan, Raven Press, 1994). She has been a Principal Investigator and co-Principal Investigator on four sequential five-year NIDA-funded projects entitled "AIDS and Drug Abuse: Policy Modeling for Better Decisions" that have led to numerous publications and presentations. Recently she has also worked in the area of bioterrorism preparedness planning, and on hepatitis B prevention and control.
She is a Fellow of the Institute for Operations Research and Management Science (INFORMS) and a member of the Omega Rho International Honor Society for Operations Research and Management Science. From INFORMS she has received the President’s Award (recognizing important contributions to the welfare of society), the Pierskalla Prize (for research excellence in health care management science), the Philip McCord Morse Lectureship Award, and the Award for the Advancement of Women in Operations Research and the Management Sciences. She has also received the Award for Excellence in Application of Pharmacoeconomics and Health Outcomes Research from the International Society for Pharmacoeconomics and Outcomes Research, and a Presidential Young Investigator Award from the National Science Foundation, among other awards. Professor Brandeau earned a BS in Mathematics and an MS in Operations Research from MIT, and a PhD in Engineering-Economic Systems from Stanford University.