HECG has extensive knowledge and experience studying the effects of health care interventions on health care costs and outcomes. HECG has studied a broad range of interventions, including prescription drugs (at various stages of development and market diffusion), clinical practice guidelines and protocols, disease management, and community and work-based prevention interventions. HECG has a well-developed capability in pharmacoeconomics, drawing on the experiences of numerous projects and several years of direct industry experience. Related areas of expertise are in risk-adjustment, outcomes measurement, and patient behavior.

HECG has also developed wide-ranging capabilities in the application of state-of-the-art techniques of economic evaluation applied to health care markets and interventions. Techniques include cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis, and return-on-investment analysis. These analyses typically include the development of a detailed decision tree mapping probabilities, outcomes, and costs.

HECG has advanced knowledge of software applications for economic evaluation (e.g., Treeage®). HECG has broad knowledge and capabilities in analyzing the structure and effects of process change, innovation, and improvement in health care settings. Examples include the effects of broad change initiatives (e.g., continuous quality improvement, total quality management, process reengineering, six sigma, etc.) and techniques of organizational performance measurement (e.g., the development of composite scores). HECG also has knowledge and expertise on the assessment of targeted process improvement programs, such as clinical practice guidelines and protocols.

The group has extensive experience collectively in the statistical analysis of large databases, including Medicare and Medicaid claims databases, commercial health plan claims databases, Medstat MarketScan® claims databases, state-level discharge abstracts, and other data provided directly by clients.

Project Examples

• Effectiveness and Cost-Effectiveness of High-Efficacy Statins among High-Risk Patients in Usual Clinical Practice. A large electronic medical record database was used to estimate the effectiveness of atorvastatin, rosuvastatin, and simvastatin in usual clinical practice for the treatment of dyslipidemia in high risk patients, as defined by the National Cholesterol Education Program Adult Panel III [NCEP ATP III] guidelines. Effectiveness was measured as percent reduction in low-density lipoprotein [LDL] and success in attaining the NCEP ATP III threshold LDL goal. The cost-effectiveness of alternative treatments also was assessed from a managed-care payer perspective, with particular attention focused on the impact of differential patient drug co-pay levels and branded drug rebates on payer costs, given the eminent transition of simvastatin from a branded to a generic drug.

• Treatment Guidelines and Patterns of Treatment for Bipolar Disorder. This project documented patterns of treatment among patients with new treatment episodes for bipolar disorder. Comparison of patterns of treatment in usual practice to treatment guidelines revealed substantial divergence from recommended treatments. The data were analyzed to identify potential predictors of divergence from recommended treatments as a means of targeting future process improvement initiatives.

• Economic Evaluation of a Point-of-Care Test for Adenoviral Conjunctivitis. This project consisted of a detailed review of the literature on the economic costs of conjunctivitis and cost-effectiveness analyses of a point-of-care test to detect the presence of adenoviral conjunctivitis. Cost-effectiveness analyses employed a range of assumptions on the prevalence of acute adenoviral conjunctivitis and direct and indirect costs associated with the condition. Data course included published literature, expert opinion, and MarketScan® commercial claims databases supplied by Medstat.

• Cost-Effectiveness of Pharmacological Treatment for Osteopenia in Postmenopausal Women. Decision-model based cost-effectiveness analysis of alternative osteoporosis treatments in postmenopausal women with osteopenia (low bone density) to reduce the risk of transition to osteoporosis and osteoporotic fractures.

• Costs of Managing Treatment-Induced Osteoporosis among Women with Breast Cancer. A large electronic medical records database was employed to determine patterns of breast cancer treatment using aromatase inhibitors among older women and pre-treatment levels of osteoporosis. These data were used to project the impact of osteoporosis treatment for new, aromatase-inhibitor-induced cases of osteoporosis on overall breast cancer treatment costs.

• Fragility Fracture-Related Medical Costs in the First Year Following a Non-Vertebral Fracture in a Managed Care Setting. Estimated fracture-related direct medical costs over a 12 month period following an incident non-vertebral fragility fracture by site for women and men age 45 or older using claims data from a large managed care system. Patterns in costs over time and by type of service were examined.

• Cost-Effectiveness of a Diabetes Education Program for Medicaid Patients. This prospective study examined the effectiveness and cost-effectiveness of an educational program to enhance self-management of diabetes among Medicaid recipients in a southern state.

• Impact of Treatment Improvements on Treatment Costs for Acute Coronary Syndrome (ACS). A decision-model-based assessment of the potential impact of more effective treatments for acute coronary syndrome on ACS-related direct medical costs.

• Cost-Effectiveness of Angiotensin-Receptor Blockers in Treating Mild-to-Moderate Hypertension. A decision-model based cost-effectiveness analysis of treatment for mild-to-moderate hypertension using alternative angiotensin-receptor blockers (ARBs), focusing on the potential impact of differences in intraday variation in blood pressure.

• Medical Care Costs Associated with Postmenopausal Estrogen-Progestin Therapy (EPT). Direct medical costs of EPT in postmenopausal therapy associated with the clinical management of therapy, including modifications of therapy (dose titration, changes in mode of administration), diagnostic testing (breast and uterine procedures), and costs of attributable adverse events of EPT, were estimated. The EPT cost estimates were obtained from claims data from a large U.S. managed care plan and from administrative data from Saskatchewan Health using different methodologies to identify attributable cost, but the resulting estimates of mean EPT management costs (after converting $Can to $US using a health-care purchasing power parity index) were very similar across the two studies.