Question 43 (10 points) Fabulous Economics Research Unit (FERU) undertook an economic evaluation alongside a clinical trial of a new medication called bowmab to treat stage 1 bowel cancer in adults aged over 18. The comparison intervention was an older chemotherapy drug called oldmid. People who consented to enter the trial were randomised to take either bowmab or oldmid by researchers who worked for the company who made the new drug bowmab. Both drugs are a single tablet of 5mg active ingredients taken orally once a day for a 6-month period. Everyone in the trial was followed up for 12 months after starting the trial (that is for 12 months starting from the baseline assessment). The following information was gathered during the 12-month trial by FERU:

Part 1: Comment on the randomisation procedure used in this study. How could the study team improve on the randomisation procedure? (points: 2) Part 2: Calculate the incremental total costs of bowmab compared to oldmid for the 12-month period of the trial? Which economic perspective has the evaluation adopted? (points: 3) Part 3: What are the incremental QALYs gained of bowmab compared to oldmid? Are these QALY gains related to mortality or morbidity gains? Explain. (points: 2)

Part 4: What is the ICER of bowmab compared to oldmid (in terms of $/QALY gained). In which of the four quadrants of the cost-effectiveness plane does the ICER sit? (points: 2) Part 5: The evaluators found that the ICER had a 99% chance of falling below a willingness-to-pay threshold of $50,000/QALY. Do you think diaformin is a cost-effective drug compared to oldaformin? (points: 1)

Bowmab $700 Oldmid $500 $800 $500 Costs of 6-month supply of each drug Average costs of other health services used by the subjects in each group (including hospitalisations, GPs, other medical services) The average QALYs gained over the 12-month period (note: nobody died during the 12 months) 0.7 0.2