Estimating Differential Value and Relative Worth:
The Differential Value-In-Use Path
In this approach we start with the same expected costs for the two types of adverse events that we used in the total value-in-use approach. From this point on, however, our path of analysis will follow a different route. Our focus here will be on just the differences between the two alternatives.
Following the differential value analysis path, we do not even look at what the cost is to a hospital of not using an anticoagulant. If standard heparin is in wide use, we simply start with the assumption that, from a typical hospital's perspective, standard heparin is a better choice than not using an anticoagulant at all. So all we need to do is to spell out how Lowparin compares with standard heparin in what it brings to a hospital.
To do that, we take Lowparin's incidence rate for each problem and subtract it from the rates for standard heparin. That gives us the level of improvement Lowparin provides over standard heparin for each problem. For post-operative clotting, Lowparin's rate is 5%, where heparin's is 7%. Subtracting 5% from 7% gives us an improvement for Lowparin of 2 percentage points over standard heparin.
With post-operative bleeding, the rate for standard heparin is 9%, while the rate for Lowparin is 10%. Subtracting 10% from 9% gives Lowparin a performance difference of - 1 %. With post-operative bleeding, Lowparin underperforms standard heparin by one percentage point.
Next we multiply the expected costs of each type of adverse event by these percentage point differentials. 2% times $5,900 gives us $118. -1% times $2,800 gives us -$28. Adding those two together, we get $90. This says that, for each abdominal surgery a hospital does, the expected difference in follow-on costs due to differences in performance between Lowparin and standard heparin is approximately $90, in favor of Lowparin. Lowparin saves $118 over heparin on postoperative clotting and falls short of heparin by $28 on post-operative bleeding. That nets out to a positive difference in Lowparin's favor of $90.
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