Exercise 1: Economic evaluation case study A consulting firm was approached by the government to help them decide whether a cervical cancer screening program was a worthwhile use of their health budget. After doing the analysis, they advised that cost per life year for cervical cancer screening was $20,000 and that the government should fund the program. The consultants costed a human papillomavirus test every 5 years for women aged 25-74 years. They assumed the screening tests would be done by general practitioners and included the costs of staff, medical instruments and pathology. They used evidence from an overseas clinical trial and estimated the cancer detection rates for Australia. Cancers detected over the 50 year period were translated into life years saved using the difference between age specific life expectancy and probable age of death without screening. They did a sensitivity analysis for variations in the cost of the screening and cancers detected, and were confident about the strength of their work. Using the checklist below as a guide, can you see any problems with their study methodology? Would you accept their advice? List the things you would do differently and things you would require clarification on. Checklist for Critical Appraisal Was a well defined question posed in answerable form? Was a comprehensive description of the competing alternatives given? Was there evidence the intended program's effectiveness had been established? Were all the important and relevant costs and consequences for each alternative identified? Were costs and consequences measured accurately in appropriate physical units? Were costs and consequences valued credibly? Were costs and consequences adjusted for differential timing? Was in incremental analysis of costs and consequences performed? PWHP'P'PP'P!' Was a sensitivity analysis performed? 10. Did the presentation and discussion of study results include all issues of concern to users