Please disregard questions 4 and 5 and only answer 6 and 7.

Cost-effectiveness analysis: "HMPers to the Rescue: Episode 1" "Hi, this is Dr. Spok from the HBHE department in SPH. We've got this great new health intervention that has improved cardiovascular health among UM employees, but we have no idea whether it passes a cost-effectiveness or cost-benefit test. Can you help?" "Yes, I can help. Just give me some more info and I'll have your answer by 2:30 pm. First, tell me more about your intervention." "Well, we implemented it five years ago for a random sample of 1,000 employees at UM and we've been tracking them and a control group of 1,000 others since then. This is a comprehensive program to improve cardiovascular health, particularly blood pressure and body weight. The intervention consists of a series of visits to exercise physiologists and nutritionists, a reduced rate at a local gym, and also motivational interviewing regarding physical activity, diet, and other aspects of lifestyle. We've already seen substantial improvements for our intervention group as compared to the controls." "Hmm, I see, that's fantastic. Let me get started and I'll call you back when I have more questions." "Excellent thanks! It's just so beautiful how everyone at SPH works together for the common good." As you sit down to begin the analysis, a few questions immediately pop into your head: You call Dr. Spek back and ask first about who the audience will be for the analysis. He is silent for several seconds, then says, "Great question. We hadn't thought that through entirely. I guess our primary audiences would be U-M as our employer...also other employers who might think about adopting our intervention. I also think that society in general should be interested in our results, though, because the intervention looks so promising!" In response to your request for more data, Dr. Spek then tells you the following: "For simplicity we've focused on two dichotomous measures: whether people are obese and whether they have high blood pressure (systolic over 140 or diastolic over 90). After one year, the breakdown for each group was as listed below, and it has remained exactly that way in each of the following four years:" Treatment group: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 20% 20% 30% 30% Control group: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 25% 25% 25% 25% Dr. Spok continued, "We had a health economist who also tracked all health service costs carefully, including the direct costs of our intervention. She recently left our group to work for the WHO, which is why we need your help now. She left with little warning, but fortunately left this note behind: Treatment group's health service costs (including intervention), per person: Year 1: $3000; Year 2: $2000; Year 3: $1000; Year 4: $1000; Year 5: $1000 Control group's health service costs, per person: 2 Year 1: $1000; Year 2: $1500; Year 3: $1500; Year 4: $1500; Year 5: $1500 You thank Dr. Spok and return to your work, noting that the clock is racing towards 2:30 pm at an unnaturally quick pace. You begin by asking yourself the following questions: 4. What is the health effect of the intervention, based on the information you have thus far? What additional information do you need, in order to translate this health effect into a unit that would be more useful to base decisions upon? [3pp] 5. What are the incremental health care costs of the intervention (relative to them control group) over the five-year time frame? Does the year-to-year pattern of incremental costs look reasonable to you? [2pp] You call Srek again and ask him how U-M would prefer to quantify health effects for the purpose of deciding whether they want to adopt the intervention permanently. Spek sighs and replies, "I just talked to one of the university bigwigs - I think the guy's name was Muhn E. Bags - and I found out that the university is thinking about this strictly from the perspective of their bottom-line. So they want the analysis to focus on how the health effects translate into increased productivity and reduced future medical costs." You thank Spok and dispatch your undergraduate research assistant to look up some numbers. Two hours later, your assistant returns with the following information, based on a review of the relevant research and data sources Average missed work-days per year due to illness, per person: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 20 10 10 5 Average cost to the university per missed work-day, in terms of productivity: $100 6. What are the net economic costs of the intervention, including both medical costs and productivity, over the five year time frame? [6pp] 3 7. Based on the information you have, would you project that the net economic costs will look more favorable for the intervention as you extend the time frame beyond 5 years? [2pp] Cost-effectiveness analysis: "HMPers to the Rescue: Episode 1" "Hi, this is Dr. Spok from the HBHE department in SPH. We've got this great new health intervention that has improved cardiovascular health among UM employees, but we have no idea whether it passes a cost-effectiveness or cost-benefit test. Can you help?" "Yes, I can help. Just give me some more info and I'll have your answer by 2:30 pm. First, tell me more about your intervention." "Well, we implemented it five years ago for a random sample of 1,000 employees at UM and we've been tracking them and a control group of 1,000 others since then. This is a comprehensive program to improve cardiovascular health, particularly blood pressure and body weight. The intervention consists of a series of visits to exercise physiologists and nutritionists, a reduced rate at a local gym, and also motivational interviewing regarding physical activity, diet, and other aspects of lifestyle. We've already seen substantial improvements for our intervention group as compared to the controls." "Hmm, I see, that's fantastic. Let me get started and I'll call you back when I have more questions." "Excellent thanks! It's just so beautiful how everyone at SPH works together for the common good." As you sit down to begin the analysis, a few questions immediately pop into your head: You call Dr. Spek back and ask first about who the audience will be for the analysis. He is silent for several seconds, then says, "Great question. We hadn't thought that through entirely. I guess our primary audiences would be U-M as our employer...also other employers who might think about adopting our intervention. I also think that society in general should be interested in our results, though, because the intervention looks so promising!" In response to your request for more data, Dr. Spek then tells you the following: "For simplicity we've focused on two dichotomous measures: whether people are obese and whether they have high blood pressure (systolic over 140 or diastolic over 90). After one year, the breakdown for each group was as listed below, and it has remained exactly that way in each of the following four years:" Treatment group: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 20% 20% 30% 30% Control group: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 25% 25% 25% 25% Dr. Spok continued, "We had a health economist who also tracked all health service costs carefully, including the direct costs of our intervention. She recently left our group to work for the WHO, which is why we need your help now. She left with little warning, but fortunately left this note behind: Treatment group's health service costs (including intervention), per person: Year 1: $3000; Year 2: $2000; Year 3: $1000; Year 4: $1000; Year 5: $1000 Control group's health service costs, per person: 2 Year 1: $1000; Year 2: $1500; Year 3: $1500; Year 4: $1500; Year 5: $1500 You thank Dr. Spok and return to your work, noting that the clock is racing towards 2:30 pm at an unnaturally quick pace. You begin by asking yourself the following questions: 4. What is the health effect of the intervention, based on the information you have thus far? What additional information do you need, in order to translate this health effect into a unit that would be more useful to base decisions upon? [3pp] 5. What are the incremental health care costs of the intervention (relative to them control group) over the five-year time frame? Does the year-to-year pattern of incremental costs look reasonable to you? [2pp] You call Srek again and ask him how U-M would prefer to quantify health effects for the purpose of deciding whether they want to adopt the intervention permanently. Spek sighs and replies, "I just talked to one of the university bigwigs - I think the guy's name was Muhn E. Bags - and I found out that the university is thinking about this strictly from the perspective of their bottom-line. So they want the analysis to focus on how the health effects translate into increased productivity and reduced future medical costs." You thank Spok and dispatch your undergraduate research assistant to look up some numbers. Two hours later, your assistant returns with the following information, based on a review of the relevant research and data sources Average missed work-days per year due to illness, per person: Obese, high BP Obese, normal BP Normal weight, high BP Normal weight, normal BP 20 10 10 5 Average cost to the university per missed work-day, in terms of productivity: $100 6. What are the net economic costs of the intervention, including both medical costs and productivity, over the five year time frame? [6pp] 3 7. Based on the information you have, would you project that the net economic costs will look more favorable for the intervention as you extend the time frame beyond 5 years? [2pp]