• First read the synopsis, cast of characters, and case study narrative in the Weinberger case..
  • https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1267/2014/10/Revised-Narrative-CEA-Case-Oct-3-14.pdf
• Then review the instructions in the PDF handout shown in the images below on how to complete Data Tables 1-4..
• Complete Data Tables 1-4.

"The Governor Is Very Interested," or, Cost-Effectiveness Analysis for School Health Screenings WRITTEN HOMEWORK ASSIGNMENT: Exercise to Estimate Cost-Effectiveness of School-Based BMI and Eating Disorder Screening Due Date: Length: Completed Tables 1-4 plus 1 page summary of the results (typed, double-spaced, 12-point font, one-inch margins) Nefertiti Nelson and her Columbia Department of Public Health (CDPH) colleagues are working with Melvin Kuo and your consulting team at Datamon to examine the cost effectiveness of BMI and eating disorder (ED) screening in schools. The following exercise will illustrate the basic steps of cost- effectiveness analysis (CEA) that you will conduct as part of the consulting team at Datamon. Costs and effects are estimated for three strategies: no screening (the status quo), BMI screening, and combined BMI and ED screening. Further, the analyses are conducted over two evaluation periods (1 and 5 years) and from two different perspectives (payer and societal). Requirements A valuable tool for any student or practitioner of public health is the Guide to Analyzing the Cost- Effectiveness of Community Public Health Prevention Approaches (2006), a publication from the U.S. Department of Health and Human Services that is available online at: http://aspe.hhs.gov/health/reports/06/cphpa/report.pdf. You are required to read the following: . Chapters 1-2 (pp. 1-1 - 1-3, 2-1 - 2-9) Chapters 4-5 (pp. 4-1 - 4-7, 5-1 -5-11) 1. Conduct a brief literature search to identify research support for early detection, specifically as it relates to improved treatment outcomes or reduced suffering, harm, or costs for eating disorders and obesity. Cite this research in the opening 2-3 sentences of your 1 page summary. 2. As discussed in Chapter 4 in the Guide to Analyzing the Cost-Effectiveness, calculations of costs in CEA often start with a list of all relevant resources necessary to execute the screening program. For the purposes of this homework assignment, we will assume that screening is followed by effective intervention/treatment among students found to have BMIs greater than the 95" percentile for age and sex or to have ED symptoms. Also all other medical care utilization that is not part of the screening program and related treatment but might change as a consequence of the screening program should be included. Finally, non-health impacts/costs should also be listed."The Governor Is Very Interested," or, Cost-Effectiveness Analysis for School Health Screenings Data Tables for Homework Assignment Table 1. Resources associated with BMI and ED screening in public schools Screening-related Future medical care Non-health costs Excluding medical care that is part of the screening-related intervention. Table 2.1. Average per person costs (hypothetical estimates) Screening-related Medical care Non-health Total societal costs State Patients or/and Schools government insurers Patients 1 year No screening SO SO $300 $400 BMI screening $200 $200 $200 $300 BMI & ED screening $300 $300 $100 $100 5 years No screening SO SO $1,000 $1,000 BMI screening $200 $200 $800 $700 BMI & ED screening $300 $300 $200 $500 "Assuming one-time screening and treatment, if necessary. These costs are expected to be incurred in the first year, and therefore do not change over longer evaluation periods. 'Excluding medical care that is part of the screening-related intervention. "Assume that the costs in the 5-year time frame have already been discounted to present value (see 2.3.4 of companion technical document). Table 2.2. Total screening-related cost of screening 200,000 children Schools State government BMI screening BMI and ED screeningTable 3. Estimation of QALYs Length of evaluation Life expectancy QALYS 1 year No screening BMI screening BMI and ED screening 5 years No screening BMI screening BMI and ED screening OALYs = quality-adjusted life years "For example, QALYs = 0.703 x 2 years + 0.700 x 2.0 years for BMI screening over 5 years where life expectancy=4.S. Table 4. Incremental costs, QALYs, and ICER Length of evaluation Incremental Incremental Incremental ICER ICER costs to societal effectiveness payer societal payers costs (QALYS) perspective perspective 1 year No screening BMI screening BMI and ED screening 5 years No screening BMI screening BMI and ED screening ICER = incremental cost-effectiveness ratio OALYs = Quality-adjusted life years "Payer costs here include ones bome by schools and the state government. "Societal costs include payer, medical care costs, and non-health costs.Fill in Table 1 by listing the resources that you think are relevant in this example. Group them into three categories: i. Program-related (resources needed to screen for and treat elevated BMI and EDs) ii. Future medical care (prevented use of health care resources associated with reduced BMI and treated ED) iii. Non-health impacts/costs (avoided non-health costs associated with reduced BMI and ED) 3. Also discussed in Chapter 4, the next step in cost-effectiveness analysis (CEA) is to estimate the costs associated with the resources above. Assume that these costs have already been calculated and aggregated as in Table 2 (note that the figures are hypothetical and include screening and treatment for children with ED and those with BMI 2 95" percentile). Estimate the total costs associated with each strategy by filling in the empty cells in table 2.1. Payers (in this case, schools and government) are often interested in the overall cost impact of new programs on their budgets. Assume that the screening program is estimated to result in 200,000 children being screened in the entire state. Estimate the overall cost (budget) impact of screening on schools and on the government by filling in Table 2.2. 4. The next step in CEA is to estimate the effectiveness associated with each screening program and related treatment. The measure of effectiveness we will use here is quality-adjusted life years (QALYs) as described in Chapter 5 of the Guide to Analyzing the Cost-Effectiveness and in line with recommendations by the US Panel on Cost-Effectiveness. Estimate the life expectancy and QALYS associated with no screening, BMI, and BMI + ED screening by filling in the shaded cells in Table 3. To estimate QALYs you need to multiply life expectancy (number of years within the evaluation period) by quality of life. Life expectancy . The 1-year evaluation assumes that there is no difference in life expectancy across alternatives (life expectancy=1). The 5-year evaluation assumes that life expectancy is 5 years when both BMI and ED screening are provided, but decreases to 4.8 years when only BMI screening is provided and to 4.6 years when there is no screening. This scenario is based on the assumption that failure to treat ED as well as very high BMI might lead to life-threatening conditions and higher mortality rate. Quality of life Typically scored on a scale from 0 (death) to 1 (perfect health); assume the following: Quality of life (no screening) = 0.701 for each of the 4.6 years Quality of life (following BMI screening) = 0.703 for the first 2 years and 0.700 for the remaining 2.8 years Quality of life (following BMI and ED screening) = 0.706 for the first 2 years and 0.7 for the remaining 3 years5. The next step in CEA is the incremental cost-effectiveness ratio (ICER), as described on page 5-5 in the Guide to Analyzing the Cost-Effectiveness. ICER represents the additional costs associated with a one unit increase in effectiveness. In this example it shows how much the payer needs to spend to gain one QALY. For example: TotalCost Filscreening - TotalCost Noscreening ICER = QALY'S Bhil screening - QALI'S Noscreening Fill in Table 4 by doing the following: . Calculate the incremental costs of BMI screening vs. no screening, and BMI and ED screening vs. no screening to payers (schools and government) and society by subtracting the per person cost of no screening from the costs of BMI screening alone or BMI and ED screening combined (columns 2 and 3). Calculate incremental QALYs of BMI screening vs. no screening, and BMI and ED screening vs. no screening by subtracting the QALYs of no screening from the QALYs of BMI screening alone or BMI and ED screening combined (column 4). Calculate the ICER of BMI screening vs. no screening, and BMI and ED screening vs. no screening from a payer (by dividing column 2 by column 4) and a societal (by dividing column 3 by column 4) perspective (columns 5 and 6, respectively). 6. Summarize the results Suggested format: (i) Provide basic evidence of the benefits of early detection and treatment with citations from the research literature (2-3 sentences) (ii) State the background and the goal of the analysis (1-2 sentences) (iii) List the categories of costs that were included in your calculations (1 -2 sentences) (iv) Explain how QALYs were calculated (2 sentences) (v) Discuss the added costs associated with screening and treatment, as well as the medical care and non-health benefits (2 sentences) (vi) Describe the estimation of ICER (1-2 sentences) (vii) Discuss the effect of the length of evaluation and the perspective of analysis (2 sentences) (viii) Summary and recommendations to the government (1-2 sentences)