Disease X is a debilitating disease that often results in hospitalization, episodes of disability, and decreased mobility. In severe cases, individuals may suffer from chronic pain, and headaches for multiple years. Currently, there are 10,000 diagnosed cases per year of Disease X. Specifically as a result of Disease X there are:

7,000 hospitalizations per year

14,000 physician visits per year

1,000 (premature) deaths (which occur if not diagnosed and treated early enough)

On average, the individuals would have lived another 17 years otherwise, 10 of those years still employed

People with Disease X, who survive, have an average HUI score of 0.55 from the time of their diagnosis of Disease X (life expectancy otherwise not affected).

They also experience, on average, 4 months off of work.

A new screening test for Disease X has been discovered by the Acme Pharma Company. The screening test can detect the presence of one of the genes that causes Disease X, several years before symptoms appear, and when medical treatments are still effective and can totally cure the disease resulting in no symptoms or any other adverse effects. As a result of the screening test there are 50% fewer cases of Disease X per year, and all of the associated adverse health outcomes fall by a similar amount. The annual costs for implementing this screening test are $80 million per year.

Some other useful information:

The average annual wage rate is $35,000

The average cost for a hospital admission for Disease X is $20,500

An average physician visit is billed at $500

Some drugs can alleviate the symptoms associated with Disease X. On average, each patient uses $5,000 of these drugs annually. Note that the above utility scores and outcomes take these effects into account.

The results of a recent survey showed that people were willing to pay $20,000, on average, to alleviate the symptoms associated with Disease X

Please provide answer to the following questions:

a) What is the total cost of illness, in any given year, associated with Disease X? (Note: use only the available information above. Is this the total COI? Is there any other information you might want to derive a better estimate?)

b) Derive the ICER associated with the new screening test in terms of lives gained, life-years gained and in terms of QALYs gained (do not consider the averted production costs).

c) Is this screening test cost-effective? Why or why not?

d) Derive the Cost-Benefit Ratio associated with the screening test