Assignment:
Decision tree exercise: You are interested in comparing the costs and outcomes over a 1-year time period of preventative strategies for postmenopausal women with osteoporosis. You plan to compare three options:
(1) Oral CalMore, 10 mg/day
(2) Nasal Cal More, 200 IU/day; and
(3); Long-acting CalMore, 70 mgonce a week. (Note: These are not real product names.) The main outcome measured is incidence of bone fracture and the effect on QALYs. Each year, about 5% of the patients tak ing once-a-day oral CalMore have a fracture (95% do not, about 10% of those taking nasal CalMore experience a fracture (90% do not, and 5% of those tak ing longacting CalMore experience a fracture (95% do not. The cost of treat ing a fracture is $3,000, and a fracture decreases a person's QALY by 0.5 QALYs. Once-a-day oral CalMore causes gastrointestinal (GIcomplications in 5% of the patients. Nasal CalMore causes nasal irritation or bleeding in 10% of the cases. Once-a-week oral CalMore causes GI complications in 2% of the patients. The average cost of treating GI complications is $200, and QALYs are decreased by 0.2. The average cost of treating nasal problems is $100, and QALYs are decreased by 0.1.
The costs per year of the three medications are: Once-a-day oral CalMore = $600 Once-a-day nasal CalMore = $800 Once-a-week oral CalMore = $1,000
-Calculate the average cost per QALY for each treatment
-Calculate the marginal cost per QALY between options 1 (oral once a day) and 2 (nasal once a day)