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Question 1 – Valuing outcomes: Outcome measures for the trial did not include a multi-attribute utility instrument or a descriptive quality of life measure. Instead, the trial collected information about transitions to stable housing and assessment of AOD problems at 6 month intervals over a 12 month study period.
(a) Using the information in the Tables 1 and 2 below, calculate incremental QALYs for H4H versus NSA over the 12 month study period. Assume that patients transition in the middle of the 6 month period (i.e. at 3 and 9 months, respectively, for the two time periods).
(b) Using the information in Tables 3 to 5, calculate the incremental monetary health and non-health benefits for H4H versus NSA over the 12 month study period. Again, assume that patients move from one health state to another in the middle of the follow-up period, i.e. at 3 months and 9 months.
(c) What other information would you need in order to evaluate the cost effectiveness (or net monetary benefits) of H4H versus NSA?
(d) List three advantages of valuing life-years in monetary terms rather than in QALY terms.
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Question 2 Discounting: From a DHS perspective, costs of the H4H programme are concentrated in the initial year of the programme. This is because H4H clients initially use services more intensively than under NSA but eventually transition to independent housing and better health states at a higher rate than under NSA.
Table 6 describes total health and housing costs of H4H and NSA under the assumption that (i) H4H participants continue to receive the H4H programme and (ii) after the initial 12 month trial period, each group is subject to trends in housing and health outcomes observed in the last 6 months of the trial for H4H and NSA groups, respectively.
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