Cost of Illness research aims to determine the total cost of a disease to the healthcare service, patients and society in general. The financial consequences of ill-health can arise from changes in the frequency of healthcare service use, the duration and intensity of healthcare consultations, the ability of patients to work in the short-term (absenteeism and sick leave) and long-term (early retirement from the workforce), and the use of other non-medical but related resources such as living aids, transport, home and car modifications. The three stages of cost analysis include identifying resources consumed in the delivery of a particular health programme, quantifying that resource consumption and multiplying resources by their relevant valuations. The NCPE is involved in projects examining costs from both a “bottom-up” and a “top-down” perspective. Economic evaluations conducting by and for the NCPE require valid costing estimates to produce useful data.




Collaborators: National Centre for Pharmacoeconomics, St. Vincent’s University Hospital Department of Neurology, Trinity College Dublin Department of Statistics.
Status: Complete
Summary: Multiple sclerosis (MS) is a chronic, disabling disease characterised by inflammation and multifocal demyelination in the central nervous system. Healthcare resource utilisation in MS has significant financial consequences for the healthcare system, patients and their families. During the relapsing-remitting phase of the disease, pharmacological and other interventions are used to treat relapses, manage symptoms, and attempt to delay disease progression. As the disease progresses, symptom management predominates, with the aim of maintaining independence and functioning both at work and at home. This often requires a complex multidisciplinary approach including inpatient, ambulatory, and home-based rehabilitation interventions under medical supervision. As the leading cause of nontraumatic neurological disability in young adults, MS imposes significant additional indirect cost burdens on society. The aim of this cost-of-illness study was to investigate the economic consequences of increasing MS disability from the perspective of the Irish healthcare payer, patients and society in general. Both direct and indirect costs were calculated in order to assess the total economic burden of MS.
Publications: Direct and indirect economic consequences of multiple sclerosis in Ireland. Fogarty, E; Walsh, C; McGuigan, C; Tubridy, N; Barry, M. Applied Health Economics and Health Policy 2014;12(6):635-645

Collaborators: National Centre for Pharmacoeconomics, Health Information and Quality Authority, National Cancer Registry of Ireland.
Status: Complete 
Summary: Management options for colorectal cancer have expanded in recent years. We estimated average lifetime cost of care for colorectal cancer in Ireland in 2008, from the health care payer perspective. A decision tree model was developed in Microsoft EXCEL. Site and stage-specific treatment pathways were constructed from guidelines and validated by expert clinical opinion. Health care resource use associated with diagnosis, treatment and follow-up were obtained from the National Cancer Registry Ireland (n=1,498 cancers diagnosed during 2004–2005) and three local hospital databases (n=155, 142 and 46 cases diagnosed in 2007). Unit costs for hospitalisation, procedures, laboratory tests and radiotherapy were derived from DRG costs, hospital finance departments, clinical opinion and literature review. Chemotherapy costs were estimated from local hospital protocols, pharmacy departments and clinical opinion. Uncertainty was explored using one-way and probabilistic sensitivity analysis.
Publications: Cost of care of colorectal cancer in Ireland: a health care payer perspective.
Tilson L, Sharp L, Usher C et al. Eur J Health

Collaborators: National Centre for Pharmacoeconomic
Status: Complete
Summary: Budget impact analysis (BIA) is an essential component in the economic evaluation of new medicines , and can be a key consideration in the reimbursement decision.1 BIAs complement cost-effectiveness analyses (CEAs) by estimating the financial consequences of adoption and diffusion of a new medicine from the perspective of a given payer e.g. national health service, insurer, hospital etc. 2 Such analyses allow the payer to assess the likely impact of the drug on the payer’s budget, and to plan for short- and long- term resource allocation. Post reimbursement, it is useful to compare budget predictions with actual expenditure to assess the reliability of prediction methods. It is difficult, ex-post, to apportion all components of costs and savings to specific treatments/conditions (Figure 1) One unambiguous component is the drug acquisition cost of the new drug itself. The objective of this study was to compare the pre-reimbursement predicted medicines budget impact with the actual medicines budget impact of high-cost medicines reimbursed in Ireland.
Publications: Predicted versus Actual Budget Impact of High-Cost Drugs in Ireland. Fogarty E, Adams R, Barry M. Abstract ISPOR 17th annual European Congress, November 2014, Amsterdam, Italy

Collaborators: National Centre for Pharmacoeconomic
Status: Complete   
Summary: The need to demonstrate value for money for new technologies has become increasingly relevant as healthcare purchasers are tasked with maximising efficiencies within limited budgets. A budget impact analysis (BIA) is a vital component of an economic assessment of a healthcare technology. It is used as a tool to predict affordability in publicly-funded healthcare systems with finite resources and to estimate the significance of the adoption of a new healthcare intervention. It can also predict how a new intervention might displace costs for a comparator drug within a given therapeutic area. 
This study aimed to evaluate the relationship between pre-reimbursement pharmaceutical submission estimates and real world data in Ireland over a three year period and determine whether estimates could be used as a proxy for real world situations. It also examined the quality of the submissions evaluated by the National Centre for Pharmacoeconomics (NPCE) in an effort to determine if further guidelines should be developed to aid the submission process.
Publications: A Review of the Quality and Accuracy of Budget Impact Models for High Cost Drugs in Ireland. Lucey S, Tilson L, Fogarty E, Walshe V, Barry M. Abstract ISPOR 19th annual European Congress, November 2016, Vienna, Austria

Hughes DA, Tilson L, Drummond M. Estimating Drug Costs in Economic Evaluations in Ireland and the UK: An Analysis of Practice and Research Recommendations. Pharmacoeconomics 2009;27(8):635-43
O'Brien, C., Fogarty, E., Walsh, C., Dempsey, O., Barry, M., Kennedy, M.J. and McCullagh, L. The cost of the inpatient management of febrile neutropenia in cancer patients – a micro-costing study in the Irish healthcare setting. Eur J Cancer Care (2015), 24: 125–132. doi:10.1111/ecc.12182
Morgan RB, McCullagh L, Barry M, Daly C. The cost of inpatient management of heart failure patients: a microcosting study in the Irish healthcare setting. Irish Journal of Medical Science (2017) 186;293 DOI:10.1007/s11845-016-1514-7</p>