June 28, 2023
When CDRP faculty affiliate David Daeho Kim was an undergraduate, like many, he presumed incorrectly that his future would include practicing medicine. A bioengineering major, he initially followed a standard premed course of study before realizing his abilities were in statistics rather than biology or engineering. Then, the year before he entered a master’s program in biostatistics at the University of Michigan, he stumbled across the web page for Harvard’s Center for Health Decision Science. Kim was fascinated by the idea of using cost-effectiveness analysis to inform how to allocate resources in decision-making. “I sent cold emails to all the faculty listed with the center asking how I could get involved in the field.”
Kim received just one reply—from Milton C. Weinstein, Henry J. Kaiser Research Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health and a member of the First Panel on Cost-Effectiveness in Health and Medicine, who suggested that Kim join a research project to learn more about decision science and economic evaluation. Kim’s first project, evaluating whether national Hepatitis C screening in Egypt was cost-effective, sealed his commitment to decision science—he loved it. And, as a PhD student in health economics at the University of Washington, he developed a worked example in the Second Panel on Cost-Effectiveness in Health and Medicine’s update of the First Panel’s report.
Now a health economist and an assistant professor in the Department of Medicine at the University of Chicago, Kim uses simulation modeling and cost-effectiveness analysis to improve efficiency in health care on topics including COVID-19 interventions, glaucoma medications, and prostate cancer screenings. To help guide decision-making with cost-effectiveness evidence, he has developed an evaluation tool he calls Criteria for Health Economic Quality Evaluation (CHEQUE).
“My primary research is thinking about how to make such resource allocation decisions,” he says. “In the US, we spend about 18% of GDP on healthcare-related activities. If we spend a lot and get back a lot, that’s a good investment. Right now, are we using our money efficiently? We have limited money we can spend, so we have to make decisions on how we best spend our resources.”
To answer this question, Kim evaluates how particular interventions may affect individual long-term health and economic outcomes using simulation modeling. I think about the ‘what-ifs,’” he says. “If certain patients take this drug, what are the long-term health benefits? How about their expected spending on health care? Are there any potential impacts on their health-related productivity or caregiver burden? Considering trades-offs involving benefits, harms, and costs inherent in alternative options, I ask, ‘Is this a good investment?’”
Though it is not possible to put a price tag on a human life, economists imagine just that with a unit called the QALY, short for “quality-adjusted life year,” a measure of quality and quantity of life expressed in terms of economic value. Researchers use the QALY to reflect how much people are willing to pay for health gains versus other goods and services. “If you could have one more year of life in perfect health, how much would you be willing to pay for it?” says Kim. “In the US, spending less than $100,000-$150,000 to gain a year of life in perfect health is generally considered a good value.”
Currently, Kim’s projects focus on obesity and food insecurity, conditions that affect millions of Americans. In a project led by CDRP PITCH fellow Jennifer Hwang, Kim is evaluating the long-term value of anti-obesity drugs, including tirzepatide, measuring potential long-term health benefits against side effects and costs. These new-generation antiobesity medications produce a loss of 15% of bodyweight in more than 20% of test subjects in clinical trials, but, at a cost of about $13,000 per year, many are concerned about its value and affordability.
“Based on the early data and the benchmark, it’s not cost effective—it’s over $250,000 per year of perfect life,” he says. “The drug industry argues that this is a good value because you invest money on drugs, reduce weight, and reduce conditions like diabetes, so overall there will be less money spent on healthcare because your health improves.” In anticipation of the possibilities, Kim is using modeling to project the cost of several scenarios that include long-term weight maintenance and reduced drug effectiveness over time. “Even though we don’t know, we can’t wait [to found out] because the drug is already FDA-approved and on the market—and insurance companies feel pressure to cover it because there is a lot of demand.”
Kim is also interested in health and social interventions to help individuals with food insecurity. In a recent project with his collaborators at Tufts [“Health and economic impacts of implementing produce prescription programs for diabetes in the US: a microsimulation study,” forthcoming in the Journal of the American Heart Association], he evaluates produce prescription programs that prescribe free or discounted fresh produce to patients with diet-related chronic diseases. They found that, for the 5.74 million Americans with diabetes and food insecurity, implementing produce prescriptions would prevent 296,000 cardiovascular disease events, cost about $45.5 billion to implement, and save about $41.1 billion for healthcare and $4.8 billion in productivity over their lifetimes. “With a net savings of $0.47 billion, the program could be highly cost-effective from a healthcare perspective and health-improving and cost-saving from a societal perspective,” says Kim.
“Resources to improve health are always limited. It’s impossible to provide all the interventions that offer health benefits without sacrificing resources that could be used for other desirable and important goals. My goal as a researcher is to put some numbers on it using a systematic approach so we better understand how much bang we get for the buck and whether we could those resources better,” says Kim.
Story and photo by Irene Hsiao