Health Economics Spotlight

Updates on VA data, health economics research, and analytic methods

June 2023

In This Issue

1. Cost of Implementing COPES: An Example of Economic Analyses in Implementation Research
2. Seminar: Marginal Effects and Predictive Margins: Choosing and Using the Right Method for Reporting Your Regression Results
3. FY22 Inpatient and Outpatient Average Cost Data Now Available
4. Archived Seminars Available Online
5. HERC Consulting Service

Spotlight

Cost of Implementing COPES: An Example of Economic Analyses in Implementation Research

Cost analyses are a growing component of implementation research. A new HERC technical report presents results from the cost analysis of Cooperative Pain Education and Self-management (COPES). COPES is a VA program that uses automated messaging to deliver in-home self-management support, which research has shown leads to comparable outcomes to in-person care. In this study, the economics study team estimated the total cost of the COPES intervention, the cost of adding COPES to additional VA medical centers, and the cost of replicating the intervention at a non-VA site. The authors also explain the methods they used to estimate costs.

Costing method: Micro-costing

To compute the costs of COPES costs, the team tracked four inputs

• Labor, supplies, office space, and contracts.

They split the COPES program into three cost categories

• variable costs, fixed costs, and sunk costs.

Table 1. Cost Components

Results

The total cost of the COPES intervention, as implemented, was $309,155 over three years. At each site, the added cost of implementing COPES was $240,877. The expected total three-year cost of the intervention was $296,454 at the national average, or $2,906 per person. If VA added COPES to more VA medical centers, the added cost would be $1,034 per person per year. To replicate the intervention at a non-VA site, the cost would be $1,705 per person per year, because of the added cost of having to create the dashboard with the non-VA site.

Resources for Economic Evaluations in Implementation Research

• Technical Report 41: Implementation Costs of the Cooperative Pain Education and Self-Management (COPES) Intervention to Deliver In-Home Self-Management Support to Veterans with Chronic Pain
• Steps to conduct economic analyses for implementation research
• Guidelines for creating an activity tracking file
• HERC's list of tools and resources for conducting economic analyses for implementation research
• Resources to learn more about the economics of implementation

Seminars

Marginal Effects and Predictive Margins: Choosing and Using the Right Method for Reporting Your Regression Results

HERC Health Economics Seminar

Wednesday, June 21 at 2pm ET

Register

Methods Core Director for the Center for Mental Healthcare and Outcomes Research; Health Economist with Behavioral Health QUERI and QUERI’s Evidence, Policy, and Implementation Center (EPIC)

The challenges of interpreting coefficients from nonlinear models (e.g., logistic models) are increasingly becoming known to health services researchers. A popular solution is to report marginal effects instead of transformations of the coefficients (e.g., odds ratios). However, other alternatives exist and may be preferable depending on the research question. This talk will discuss important nuances of marginal effects and introduce predictive margins as a tool for interpreting regression output.

Target audience: This talk is aimed at health services researchers who want to clearly communicate results from regression models; no prior knowledge of marginal effects is required but familiarity with nonlinear models will be helpful.

All supporting materials for Dr. Raciborski's talk will be available for attendees at https://github.com/zabcia/trainings/tree/main/herc23_margins

Data

FY22 Inpatient and Outpatient Average Cost Data Now Available

HERC Inpatient and Outpatient Average Cost data are updated for FY22 and available on VINCI. These data are estimates of encounter level costs for VA care. Data include estimates for 12 types of outpatient care and 11 types of inpatient care.

An overview of Inpatient and Outpatient Average Cost data is available on the HERC website. Guidebooks provide detailed descriptions of the methods used to prepare the estimates and a user's guide for working with the data.

Information about accessing HERC Average Cost Data is available on the VHA Data Portal (VA intranet only).

Guidebooks

• HERC's Average Cost Datasets for VA Inpatient Care
• HERC's Outpatient Average Cost Dataset for VA Care (VA intranet only) 

Resources

Archived HERC Seminars Available Online

Did you know that all past HERC cyberseminars are available online? Visit the HSR&D website to view videos of past presentations. Slides and transcripts are also available for download.

Interested in browsing past seminars? A list of HERC seminars from the past 3 years are available on the HERC website.

Recent HERC Econometrics Seminars

• Cost as the Dependent Variable
• Empirical Bayes
• Fixed Effects and Random Effects
• Limited Dependent Variables

Resources

HERC Consulting Service

Are you a VA researcher and have a question or need help from HERC? We provide consultation services on topics such as

• VA cost data
• Methods for economic evaluations, including cost-effectiveness analysis and budget impact analysis
• Method to micro-cost (direct measure) the resources used to provide innovative health care services
• Econometric analysis of health care costs and observational data
• Measure of preference based health utilities, the measure needed to express outcomes in terms of Quality Adjusted Life Years (QALYs)
• Other questions for which an economist's input might be helpful

Visit the HERC website to learn more about contacting our consulting service.