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Economic Costs of Cancer Health Disparities: Summary of Meeting Proceedings 45
Glossary
Cost: resources spent to purchase
Cost-utility analysis (CUA): eco-
Incidence-based model: quantifi es the
services or other resources includ-
nomic analysis in which the conse-
total lifetime costs of new cases of an
ing direct, indirect, and intangible
quences are expressed as the utility
illness with onset in the base year.
components.
or quality of the health outcome.
CUA results are generally expressed
Incremental cost-effectiveness:
Cost analysis: economic evaluation
as cost per quality-adjusted life year
difference in cost to achieve an
that focuses on the costs of the
(QALY) gained, recognizing that
additional amount of benefi t with a
intervention and does not consider
all life years are not equivalent and
treatment strategy usually expressed
health outcomes.
taking into account pain, discomfort,
in dollars per year of life gained.
and other factors.
Cost-benefi t analysis (CBA):
Incremental cost-utility: difference in
economic analysis in which both the
Contingent valuation (CV): method
cost to achieve an additional amount
inputs to produce the intervention (or
involves directly asking people, in
of quality-adjusted benefi t with a
costs) and its consequences or benefi ts
a survey, how much they would be
treatment strategy usually expressed in
are expressed in monetary terms of net
willing to pay for specifi c services. It is
dollars per QALY gained.
savings or a benefi t-cost ratio.
called “contingent” valuation, because
people are asked to state their willing-
Indirect costs: cost associated with
Cost-effectiveness analysis (CEA):
ness to pay, contingent on a specifi c
the morbidity or mortality of illness
economic analysis in which the conse-
hypothetical scenario and description
beyond the direct provision of care.
quences or effects of the intervention
of the service.
are expressed in natural units such as
Indirect institutional costs: costs
years of life saved, lives saved, cases
Direct costs: medical and nonmedical
associated with the operation of the
screened, or cases successfully treated.
costs associated with the provision of
institution not directly associated with
medical services for the prevention,
patient care and for which a charge is
Cost-minimization analysis (CMA):
diagnosis, treatment, followup, reha-
not generated.
When two alternatives have been
bilitation, and palliation of illness.
shown to have equivalent clinical
Intangible costs: poorly defi ned
effectiveness, only their costs need
Discount: adjustment in benefi t or
costs associated with illness including
to be compared to identify the most
cost in the future relative to benefi t
pain and suffering and loss of
economically desirable alternative.
and cost in the present.
companionship.
Cost-of-illness study (COI): analysis
Effectiveness: measurement of treat-
Intermediate outcomes: interim
that computes the total costs incurred
ment effect in the population in the
measures of assessment of benefi t of an
by society as a consequence of a speci-
“real world” setting. That is, based
intervention (e.g., late stage diagnosis,
fi ed health care problem, typically
on patient care received outside of a
lower rate of treatment success).
including both the direct and the
clinical trial.
indirect costs—such as medical costs
Life expectancy: average number of
and lost productivity—associated with
Effi cacy: measurement of treat-
years of life remaining at a given age.
an illness. There is no comparison of
ment effect based on fi ndings from a
treatment alternatives.
controlled setting such as within the
Prevalence-based model: quantifi es
context of a randomized clinical trial.
economic costs by measuring all costs
Cost-to-charge ratio: method of
due to illness occurring within a given
estimating cost based on charges and
Final Outcomes: health outcomes
time period, usually a single year,
assumed distribution of costs per
that are measures in terms of mortal-
regardless of the time of disease onset.
unit charge.
ity, morbidity, and health-related
quality of life.
46 Economic Costs of Cancer Health Disparities: Summary of Meeting Proceedings Quality of life (QOL): social, physical, emotional, psychological, and
general well-being of individuals,
typically measured using standardized
questionnaires or interviews, such as
the SF-36, SF12 or EuroQOL (EQ-
5D). When assessed in the context of
health and medicine, QOL is termed
health-related quality of life (HRQL).
Sensitivity analysis: process of assess-
ing the change in expected value or
threshold values based on variation
of the probabilities or outcome values
assumed in a decision model over a
range of possible values.
Threshold: value of a variable evalu-
ated in a sensitivity analysis where
the expected values of the decision
choices are exactly equal.
Utility: measured patient preference
for a given health outcome state.
Willingness-to-pay analysis: measures
the amount an individual is willing to
pay to acquire some good or service.
This approach is used in performing
CBA.
Economic Costs of Cancer Health Disparities: Summary of Meeting Proceedings 47
Appendix A Final Participant List
Economic Costs of Cancer Health Disparities Think Tank - Center to Reduce Cancer Health Disparities
National Cancer Institute • December 6-7, 2004
Speakers
Jeanne Ringel, Ph.D.
Peter Bach, M.D.
Economist, RAND Corporation
Assistant Attending Physician,
Harold Freeman, M.D.
1700 Main St
Memorial Sloan-Kettering Cancer
Director, Center to Reduce Cancer
P.O. Box 2138
Center
Health Disparities
Santa Monica, CA 90407-2138
1275 York Ave
National Cancer Institute
Phone: 310-393-0411 Ext. 6626
New York, NY 10021
6116 Executive Blvd., Suite 602
Email: ringel@rand.org
Phone: 646-735-8137
Rockville, MD 20854
Fax: 646-735-0011
Phone: 301-594-1027
Cathy Schoen, M.S.
Email: bachp@mskcc.org
Fax: 301-435-9225
Vice President,
Email: hfreeman@mail.nih.gov
The Commonwealth Fund
Cathy Bradley, Ph.D.
One East 75th St.
Associate Professor, Department
Martin Brown, Ph.D.
New York, NY 10021
of Medicine
Chief, Health Services and
Phone: 212-606-3800
Michigan State University
Economics Branch
Email: cs@cmwf.org
Tower B
National Cancer Institute
B413 Clinical Center
Executive Plaza North
Kenneth Thorpe, Ph.D.
East Lansing, MI 48824-1313
6130 Executive Blvd. Room 4000
Professor and Chair,
Phone: 517-732-3405
Rockville, MD 20852
Rollins School of Public Health
Email: bradle81@msu.edu
Phone: 301-496-5716
Emory University
Fax: 301-435-3710
1518 Clifton Rd., NE
Mark Clanton, M.D., MPH
Email: brownm@dcpcepm.nci.nih.gov
Atlanta, GA 30322
Deputy Director,
Phone: 404-727-3373
Offi ce of Cancer Care
Mark McClellan, M.D., Ph.D.
Fax: 404-727-9198
Delivery Systems
Director, Center for Medicare and
Email: kthorpe@sph.emory.edu
National Cancer Institute
Medicaid Services
31 Center Drive, Building 31/10A03
200 Independence Ave SW
Bethesda, MD 20892
Suite 314 G
Participants
Phone: 301-451-1315
Washington, DC 20201
Email: mark.clanton@nih.hhs.gov
Phone: 202-690-6726
Stuart Altman, Ph.D.
Email: mark.mcclellan@cms.hhs.gov
Professor,
Craig Earle, M.D., M.S.c
The Heller School
Department of Health Policy
Scott Ramsey, M.D., Ph.D.
Brandeis University
& Management
Fred Hutchinson Cancer
P.O. Box 549110/ MS 035
Dana Farber Cancer Institute
Research Center
Waltham, MA 02454-9110
454-STE 21-24
1100 Fairview Ave. North, M2-B230
Phone: 781-736-3803
44 Binney Street
Seattle, WA 98109
Email: altman@brandeis.edu
Boston, MA 02115
Phone: 206-667-7846
Phone: 617-632-5564
Fax: 206-667-7264
Peter Arno, Ph.D.
Fax: 617-632-2270
Email: sramsey@fhcrc.org
Professor, Department of
Email: craig_earle@dfci.harvard.edu
Epidemiology and Population Health
Montefi ore Medical Center
Albert Einstein College of Medicine
111 East 210 Street
Bronx, NY 10467
Phone: 718-652-4631
Email: parno@montefi ore.org
48 Economic Costs of Cancer Health Disparities: Summary of Meeting Proceedings Sam Harper, MSPH
James Lubitz, MPH
Gerald Riley, MSPH
Center for Social Epidemiology
Acting Chief, Aging and Chronic
Social Science Research Analyst,
and Population Health
Diseases Statistics Branch
Center for Medicare and Medicaid
School of Public Health
National Center for Health Statistics
Services
University of Michigan
Center for Disease Control
7500 Security Blvd., MS C3-20-17
Ann Arbor, MI 48104-2548
& Prevention
Baltimore, MD 21244-1850
Phone: 734-615-9224
3311 Toledo Road, MS 6209
Phone: 410-786-6699
Fax: 734-998-0006
Hyattsville, MD 20782
Fax: 410-786-5534
Email: sbharper@umich.edu
Phone: 301-458-4354
Email: griley@cms.ggs.gov
Fax: 301-458-4037
Stephen Katz, M.D., Ph.D.
Email: jlubitz@cdc.gov
Brian Smedley, Ph.D.
Director, National Institute of
Program Director, Institute
Arthritis and Musculoskeletal
John Lynch, Ph.D.
of Medicine
and Skin Diseases
Associate Professor, Epidemiology
The National Academies
Bldg. 31, Room 4C32
Department
500 Fifth Street, NW
31 Center Dr. - MSC 2350
School of Public Health
Washington, DC 20001
Bethesda, MD 20892-2350
University of Michigan
Phone: 202-334-1755
Phone: (301) 496-4353
1214 S University, Room 236
Email: bsmedley@nas.edu
Fax: (301) 402-3607
Ann Arbor, MI 48104-2548
Email: katzs@mail.nih.gov
Phone: 734-615-9211
Robert Topel, Ph.D.
Fax: 734-998-0006
Professor, University of Chicago
Raynard Kington, M.D., Ph.D.
Email: jwlynch@umich.edu
1101 East 58th Street
Deputy Director
Chicago, IL 60637
National Institutes of Health
Willard Manning, Ph.D.
Phone: 773-702-7524
1 Center Drive
Professor, University of Chicago
Fax: 773-702-2699
Bethesda, MD 20892
1155 E. 60th Street., #1176
Email: robert.topel@gsb.uchicago.edu
Phone: 301-496-7322
Chicago, IL 60637
Fax: 301-402-2700
Phone: 773-834-1971 or
Email: kingtonr@od.nih.gov
73-702-2067
Observers
Fax: 773-702-1979
William Lawrence, M.D., M.S.
Email: w-manning@uchicago.edu
Richard Bragg, Ph.D.
Agency Health and Research
Minority Health Services
Quality/COE
Ernest Moy, M.D., MPH
Research Coordinator,
540 Gaither Road, Suite 6024
Senior Research Scientist,
Offi ce of Research, Development,
Rockville, MD 20850
Center for Outcomes and
& Information
Phone: 301-427-1517
Effectiveness Research
Research and Evaluation Group
Fax: 301-427-1520
Agency for Healthcare Research
Centers for Medicaid & Medicare
Email: william.lawrence@ahrg.hhs.gov
and Quality
Services
540 Gaither Road, 6th Floor
7500 Security Boulevard,
Joseph Lipscomb, Ph.D.
Rockville, MD 20850
MS C3-19-07
Professor, Dept. of Health Policy
Phone: 301-427-1329
Baltimore, MD 21244-1850
& Management
Fax: 301-427-3211
Phone: 410-786-7250
Rollins School of Public Health
Email: ernest.moy@ahrq.hhs.gov
Fax: 410-786-5534
Emory University
Email: richard.bragg@cms.hhs.gov
1518 Clifton Road NE, Room 642
Atlanta, GA 30322
Phone: 404-727-4513
Fax: 404-727-9198
Email: jlipsco@sph.emory.edu
Economic Costs of Cancer Health Disparities: Summary of Meeting Proceedings 49
Dionne N. Burt
Michael C. Gibbons, M.D., MPH
Tarsha M. McCrae, M.P.H., CHES
Program Specialist, Offi ce of the
Associate Director,
Public Health Analyst,
Director
Johns Hopkins Urban Health Institute
Health Policy Branch
National Cancer Institute
Asst. Professor of Public Health and
Center to Reduce Cancer Health
6116 Executive Boulevard
Medicine
Disparities
Suite 602, MSC 8341, Rm 6043
Johns Hopkins Medical Institutions
National Cancer Institute
Bethesda, Maryland 20892
111 Market Place, Suite 850
6116 Executive Boulevard
Phone: 301-594-1027
Baltimore, MD 21202
Suite 602, MSC 8341, Rm 6030
Fax: 301-480-1805
Phone: 410-895-1108
Bethesda, MD 20892
E-mail: burtd@mail.nih.gov
Fax: 410-895-1111
Phone: 301-435-9211
Email: mgibbons@jhsph.edu
Fax: 301-435-9225
Kenneth C. Chu, Ph.D.
E-mail: mccraet@mail.nih.gov
Chief, Disparities Research Branch
Frank E. Jackson
National Cancer Institute
Program Director,
Arthur Meltzer, Ph.D.
6116 Executive Boulevard
Disparities Research Branch
Research Analyst,
Suite 602, MSC 8341, Rm 6025
National Cancer Institute
Research and Evaluation Group
Bethesda, Maryland 20892
6116 Executive Boulevard
Offi ce of Research, Development,
Phone: 301-435-9213
Suite 602, MSC 8341, Rm 6027
& Information
Fax: 301-435-9225
Bethesda, Maryland 20892
Centers for Medicare & Medicaid
E-mail: chuk@mail.nih.gov
Phone: 301- 496-8680
Services
Fax: 301-435-9225
7500 Security Blvd., MS C3-19-07
Jane MacDonald Daye, M.A.
E-mail: fj12i@nih.gov
Baltimore, MD 21244-1850
Special Assistant & Public
Phone: 410-786-9976
Health Advisor,
Julaine King, MPH
Fax: 410-786-5515
Offi ce of Director
Contractor, Center to Reduce Cancer
Email: ameltzer@cms.hhs.gov
National Cancer Institute
Health Disparities
6116 Executive Boulevard
National Cancer Institute
Renee Mentnech, M.S.
Suite 602, MSC 8341, Rm 6041
6116 Executive Blvd., Suite 602
Director, Division of Benefi ciary
Bethesda, Maryland 20892
Rockville, Maryland 20852
Research
Phone: 301-594-5946
Phone: 301-402-2177
Research and Evaluation Group
Fax: 301-435-9225
Fax: 301-435-9225
Offi ce of Research, Development,
E-mail: dayej@mail.gov
Email: kingju@mail.nih.gov
& Information
Centers for Medicare & Medicaid
Kaytura Felix-Aaron, M.D., MPH
Francis X. Mahaney, Jr.
Services