Shadowing Practice: Cost of Illness, Budget Impact Analysis - Learn English Speaking with Video
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to yeah now it's recorded in progress uh
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and i will ask you to uh
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if you can uh switch off your camera uh first uh switch off your microphone too
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and i will give the word to pavel the organizer of this webinar.
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Paweł, the floor is yours.
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Thank you, Denny.
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Hello, everybody.
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Here Paweł Kowalek, Working Group 4 leader.
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I would like to welcome you to Enota's sixth webinar on pharmacoeconomics.
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The entire webinar will be recorded and will be available on the Enota YouTube channel soon.
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Today's webinar is one of a series of webinars.
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We have planned a total of 10 webinars, which we started in the beginning of this year.
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In February, we had the first one.
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And the next meetings will be held in the following months, as you can see until the end of this year.
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Each webinar will last 30 minutes with approximately 20 minutes for the presentation
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and 5 to 10 minutes for Q &A session and discussion.
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The title of today's presentation is Cost of Illness
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and Budget Impact Analysis and the lecture will be given by Dr. Medhab Cekmak -Barsbay from Ankara University, Turkey.
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Medhap is an associate professor of healthcare management at the Faculty of Health Sciences, Ankara University.
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Her research interests focus on burden of disease,
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evaluation of health policy and politics, and program assessment methods.
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She teaches health planning, comparative health systems, and health economics in several programs at her university.
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So, Madhav, please start your presentation.
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The floor is yours.
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Thank you.
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Hello everyone and thank you for attending today's session.
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Let me share my screen.
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Yes, today I'll explain to you some basic details of cost of illness analysis and budget impact analysis.
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They are two important tools of economic evaluation techniques and let me firstly explain cost of illness analysis.
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It has some relations with budget impact analysis, as you see.
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We compare current situation and new tax.
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This can be a new method,
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this can with new tech or new intervention so we could compare their costs regarding a specific illness
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and by calculating the difference these methods we will complete on budget impact analysis
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So, I'll explain some steps of cost of illness analysis.
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Firstly, we should set our purpose.
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We should start by definition.
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What should we compare?
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What should be benchmark?
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And then our perspective is really important.
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generally health system or payer perspective
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and sometimes a pharmaceutical company's perspective can be included in this analysis
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and if we want to combine all of them then the perspective is according to society,
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it combines them all.
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And then we should go with the specific disease and then we should...
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decide cost analysis approach.
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This can be incidence -based and or a prevalence -based
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and then cost analysis method we should conclude bottom -up
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or top -down method
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and then we will we should list the costs tangible intangible costs according to our perspective
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and we should collect data data and analyze
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and reports our results cost of illness analysis is related to who bears the costs
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and who enjoys the benefits so how long costs
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and outcomes are measured and what costs
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and outcomes are included these are the main questions when we are um focusing in cost of illness analysis.
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As I said earlier, study perspective is really important,
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a good starting point with determining study perspective in a really detailed way.
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It's a viewpoint from which an analysis is conducted and refers to
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which costs and benefits are included and this can be a government's perspective,
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payer perspective, even a patient's perspective and as I said if we combine the most society perspective is the most general one.
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When we In calculating costs,
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we should discriminate direct medical costs and indirect costs.
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Direct costs generally refers to the costs of diagnostic tests, drug costs, physician office visits,
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biologics and medication, surgery, hospitalization, these kinds of costs.
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And as you see here,
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the major contributors of the total health expenditure of Crohn disease were biologics at €5 ,000 and medications,
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nearly €3 ,000, followed by hospitalization, €2 ,000 euro
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and surgery it's less than hospitalization but it's very near to two thousand euro and
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we are going with the direct medical costs imported portugal the annual average cost per IBD patient is 6 ,000 euro.
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60 % is related to Crohn's disease and 40 % to ulcerative colitis.
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So direct costs are easy to calculate
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but indirect costs are not easy as direct costs
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because they include productivity losses
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and every kind of costs especially we cannot turn them into monetary units
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so indirect costs include every kind of impacts of patient and caregiver particular participation in an intervention.
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So these costs are generally much more complicated to measure than other kinds of tangible costs.
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You see a publication here exploring work productivity laws in patients with inflammatory bowel disease.
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In this article,
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it was aimed to evaluate the impact of inflammatory bowel disease on patients' professional life
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and to determine predictors of several work productivity loss.
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And when we looked at the results,
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we see absenteeism were calculated reported. And in multivariate analysis,
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these work productivity laws in these patients are analyzed and reported in results.
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And budget impact analysis is a kind of estimation,
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the financial consequences of any kind of intervention or new drugs
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and we should calculate and we should see the financial impact on annual health care use and cost for the first,
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the second and subsequent years according to our time horizon it can be one year,
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three years, five years and SPOR suggests that it can start from one year to five years.
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So according to your model, according to your time horizon,
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these estimates should exceed to five years.
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Budget impact models rely on robust estimates for market share also market share uptake of the new therapy or intervention being introduced.
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These therapies are highly costed so we should know if we can afford these kinds of drugs or interventions.
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So in terms of patients view,
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in terms of insurance perspective and healthcare policy makers and for evidence -based decision making,
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these affordability decisions are really important to pay for them or not.
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So if we are coming across with new therapies,
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every new therapist should follow with budget impact analysis to see these informed decisions.
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Budget Impact Analysis is a tool to forecast the impact and it has many approaches, many
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forecasting methods on a new intervention on payer budgets
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and takes into account the whole healthcare system in a national perspective or in a regional perspective according to your setting
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and it provides us a benchmarking for evidence -based decision making
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because if we know Although it's cost effective and it's affordable,
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we can conclude to reimburse the new drug.
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For this reason, reimbursement decisions should rely on these kinds of analysis,
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especially new drugs and new medications,
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new methods for reimbursement agencies and there are some national guidelines
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and they set all the details in these guidelines.
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Some countries like Belgium, like Netherlands, they have some specific, like Canada,
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they have budget impact analysis methods in detail,
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especially for pharmaceutical campaigns for their new drugs.
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When we are doing budget impact analysis,
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firstly, we should estimate the eligible population uptake.
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So, we should know who are suffering from this disease and the population suffering from this disease.
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And we should select the time horizon.
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It can be start from one year to five year.
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And then we should identify current and the new projected treatment mix.
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And we should benchmark and compare the two of them.
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And then we should estimate current and future drug costs and disease -related other kinds of costs like surgery,
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hospitalization, or every kind of costs.
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As I said, productivity loss costs also can be included.
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And estimating and presenting changes in annual budget impact and health outcomes.
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These are the.. the main steps of budget impact analysis.
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There are different approach in this analysis.
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The first one is epidemiology analysis.
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We should start with prevalence or incidents defining with the population like PICO questions,
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PICO's questions, what's our population?
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And we should have real time data on the share of the treated patients.
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And then we should know the healthcare resources and the related costs,
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especially associated with disease, with this disease, hospital visits, the duration of the visits,
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the duration of the hospitalization, surgery, if it should to exist or not,
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outpatient appointments, TDM tests, the count of these healthcare resources.
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And the other one is market analysis, estimating market share, it's important for pharmaceutical companies,
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it's important for new drugs.
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Also, analysis of the cost of the treatment.
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These are the four key variables.
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In any of them, we should take into consideration the cost components like unit drug costs
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or monitoring and administration of this drug that's subcutane or intravenous
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or how should we implement it possible adverse events related to these drugs and disease -related healthcare utilization,
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diagnostic, hospitalization, surgery, or outpatient visits.
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Firstly, these should be with cost effective analysis.
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They are combined.
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We distinguish the two of them from a cost -effective analysis.
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They are some common steps, common methods, some distinct features, distinct characteristics.
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And as you see a perspective and time horizon,
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we should generally use payer perspective because if we should conclude with reimbursement decisions,
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a payer perspective is it's okay.
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But so if we, for example,
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needs and many countries recommends everyone not to use only a payer perspective,
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rather society perspective, rather the especially intangible costs are really important for this reason.
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They want to include all the productivity laws or other intangible costs.
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So when we want to design the characteristic of the disease,
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what's the type, what's the situation in the society, and what's the current and new treatment,
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what's the characteristic of this disease,
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the epidemiological characteristics, and also we should know about the health system,
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the health system, especially financing measures are important,
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and scenario analysis
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um are important uh what are the existing threatened modalities in
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scenario analysis we assume uh some uh different scenarios uh some uh possible costs relate to this disease and then
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Then PICO questions, population intervention,
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comparatory outcome and settings, population is the target population,
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we should decide eligible population for treatment with the new alternative for patients suffering from this disease.
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And we should have some data sources,
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especially for epidemiologic nature of this disease.
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And market share should be determined among eligible populations and existing alternatives.
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And costing steps include all eligible costs, induction, maintenance, follow -up costs,
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and discounting and sensitivity analysis.
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Generally in budget impact analysis,
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no discounting is applied because discounting is meaningful in longer period,
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longer horizons, especially for lifelong periods.
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But we should calculate all the costs for one year or three years for this reason.
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No discounting is relevant in budget impact analysis this.
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And first the market product,
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this is one of the four variables.
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This concept is the first of its kind to enter a specific therapeutic market.
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It's relevant for a novel therapeutic class, especially important for first biologics in its indication.
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And biosimilar, that's the first challenge of branded biologic.
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And there are some approaches market share can be estimated in terms of units
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or sales and top down and bottom up approach can be applied.
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And And we should get data related to the consumption characteristics,
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and then go with the projections and forecasting.
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Initial market advantage allows for rapid uptake and higher adoption rates, especially if there's unmet need.
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In this case, health policy makers make some distinguished decisions for this initial market
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to get this initial market advantage on behalf of a pharmaceutical company.
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And we assume that the initial price benchmark is set
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and this influences cost for treated patients and comparative cost scenarios when other competitors enter the market.
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In the case of biosimilars,
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a first -to -market biosimilar can reduce costs significantly and influence the price of follow -on entrants.
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And go with the uptake patterns
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and payers may give preferential access to the first product if it addresses an unmet need or it's calculated cost -effective.
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So that cost -effective analysis will be combined with budget impact analysis.
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Early adoption patterns influence the budget forecast, especially high uptake early on,
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a higher short -term budget impact or strategic pricing or discounts can mitigate this impact.
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And there are some static or dynamic models,
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especially taking into consideration the characteristic of the population.
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They are static or the dynamic population.
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The number of patients are stable or they are reducing or increasing.
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This is the main distinction of these two models.
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And these models should combine with scenario analysis and sensitivity analysis also.
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And we get some savings with this budget impact on this and what to do with the savings.
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This is important for new therapies.
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for biosimilars to the first market significant price drops
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or reference products these kinds of savings can be used to reinvestment for new therapies and or expanding access to
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the disadvantaged patients
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This is the example of the uptake of the neodrack inhibitor versus older biologics.
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Price premium of the being first and the impact on health budget
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if it replaces costier intravenous infusion and sensitivity analysis will examine impact if a second drug enters market in year
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three and market erosion for older drugs due to first market dynamics to complete market penetration
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and adaptation speed and price setting power competitive landscape assumption overall short and medium -term budget estimates.
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So budget impact models and analysis, especially for chronic inflammatory diseases
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where innovation and highly cost new drugs first market status should be explicitly modeled as a scenario or sensitivity analysis.
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that's all thank you for attending this session if you have any questions and
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comments please feel free to ask and go with your comments
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okay thank you very much do the audience have any questions to our presenter
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i would like to start with a few questions when you when you say when you talk about the payers
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the payers are the government right right okay and uh
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and you talk about the budget impact borders uh you mentioned that the the netherlands belgium and canada have applied this uh
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BIA, so Budget Impact Analysis,
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does it reduce, what is the budget for health in this country?
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It's important for especially new drugs, new therapies.
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So if a pharmaceutical company should come to the market with a new therapy,
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with a new drug, it should, they should, the company should apply the rules of the guidelines of
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that country for implementing all the details in budget impact analysis.
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So we don't know exactly if this budget impact analysis
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or this budget impact analysis is models are efficient in uh maintaining a sort of sustainability of the healthcare system
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because in france uh the budget uh for health care system is is we have a debt
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so it was 12 or 11 billion
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in 2024 or 2023 and it has become 20 billion
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so it is increasing so we we i think we need this uh
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yeah the decision to uh to make it uh the budget sustainable
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because it it it increase dramatically so maybe we are paying too much
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or maybe the the prices are
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so too high even in france i'm not speaking about uh serbia i was uh last week in eular
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so there was a serbian rheumatologist
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and he said the price cannot cannot it is too high
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and the agency refused to provide to reimburse some projects for rare disease like it yeah for example some countries
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that are in a resource constraint situation and they tend to reimburse not the original drugs,
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the generic drugs.
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So this is the main tool and easy tool to reduce the drug -related costs in that country.
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So if we really need to access new therapy and very expensive therapy,
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What can we do for patients,
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for disadvantaged people, especially if the healthcare decision makers decided not to reimburse that drug?
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And I can tell you that the rheumatologists are thinking about this
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because it was one of the uh one of the topic
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uh the prize of the the drugs uh during the last meeting so
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does anyone would like to to ask a question to meta
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yeah yeah my comment is that new technologies very often borne budget constraints and
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it could be seen more and more often indeed okay do we have any other comments
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or questions from our audience i don't see
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so i would like to invite you for the next webinar
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which will be held in
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which will be held on 8 of July this year from 5 to 5 30 set pm
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and the speaker will be Przemysław Holko from the Jagiellonian University Medical College from Poland
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and the title of the webinar would be basics of stochastic thinking
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and mark of modeling so please register to the next webinar
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and thank you for the attending and participating this meeting
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and see you at the next webinar next month thank you
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thank you thank you bye bye have a safe day safe evening bye bye thank you you're welcome bye bye
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Vocabulary and speaking notes for this lesson
This C1 speaking lesson is built on the video “Cost of Illness, Budget Impact Analysis”. The speaker keeps coming back to these words: cost, analysis, budget, impact, drug. This video has 257 sentences and 2872 words to shadow. The speech runs for 32:38. The speaker talks slowly, about 88 words per minute, so there is time to copy every sound. 82% of the words are among the 3,000 most common in English; the rest is worth studying before you start.
Key vocabulary in this video
The 15 most advanced words in the video, with pronunciation and meaning:
| Word | Pronunciation | Meaning |
|---|---|---|
| webinar noun | /ˈwɛb.əˌnɑː/ | An interactive seminar conducted via Internet. Usually a live presentation, lecture or workshop that happens in real time, as users participate through… |
| payer noun | /ˈpeɪ.ɚ/ | One who pays; specifically, the person by whom a bill or note has been, or should be, paid. |
| calculate verb | /ˈkælkjʊleɪt/ | To determine the value of something or the solution to something by a mathematical process. |
| hospitalization noun | /ˌhɑ(ː)s.pɪ.tə.lɪˈzeɪ.ʃən/ | The hospitalizing of a patient, the condition of being hospitalized, or the period a patient stays in hospital. |
| uptake noun | /ˈʌpteɪk/ | Understanding; comprehension. |
| characteristic noun | /ˌkæɹ(ə)ktəˈɹɪstɪk/ | A distinguishing feature of a person or thing, a part of mental or physical behavior. |
| pharmaceutical adjective | /ˌfɑː.məˈs(j)uː.tɪ.kl̩/ | Of or relating to pharmacy or pharmacists. |
| biologic adjective | /bʌɪəˈlɒdʒɪk/ | Biological; pertaining to biology or to a living organism. |
| biosimilar noun | A variant of a biopharmaceutical that is marketed following the expiry of the original patent. | |
| reimburse verb | /ˌɹiːɪmˈbɜː(ɹ)s/ | To compensate (someone) with payment; especially, to repay money spent on someone's behalf. |
| benchmark noun | /ˈbɛn(t)ʃmɑːk/ | A standard by which something is evaluated or measured. |
| firstly adverb | /ˈfɜɹstli/ | In the first place; before anything else; first. |
| sensitivity noun | /ˌsɛn.səˈtɪv.ə.ti/ | The quality or state of being sensitive; sensitiveness. |
| horizon noun | /həˈɹaɪ.zən/ | The visible horizontal line (in all directions) where the sky appears to meet the earth in the distance. |
| forecast noun | /ˈfɔːkɑːst/ | An estimation of a future condition. |
Phrasal verbs you will hear
| Word | Meaning |
|---|---|
| switch off verb | To stop or disable a device by turning a switch or a lever. |
| come across verb | To change sides; to cross over to work for the opposition. |
| follow up verb | To take further actions remaining after an event; to continue, revisit, or persist; especially, to maintain communication or verify. |
Grammar in this video
The structures the speaker uses most, with the exact words from the video:
| Structure | In the video |
|---|---|
| Passive voice be + past participle — the focus is on what happens, not who does it | will be recorded · will be held · is Cost |
| Present perfect have/has + past participle — a past action that still matters now | have planned · have applied · has become |
Pronunciation to watch
The speaker uses 6 contractions and reduced forms, such as don't, I'll, I'm. Say them the short way, as you hear them.
- The “th” sounds: therapeutic /ˌθɛɹ.əˈpjuː.tɪk/, threaten /ˈθɹɛt.n̩/, therapist /ˈθɛɹəpɪst/
- The “sh” and “zh” sounds: hospitalization /ˌhɑ(ː)s.pɪ.tə.lɪˈzeɪ.ʃən/, benchmark /ˈbɛn(t)ʃmɑːk/, outpatient /ˈaʊtˌpeɪʃ(ə)nt/, distinguish /dɪˈstɪŋ.ɡwɪʃ/, erosion /ɪˈɹəʊʒən/
- Long words — get the stress right: hospitalization /ˌhɑ(ː)s.pɪ.tə.lɪˈzeɪ.ʃən/, characteristic /ˌkæɹ(ə)ktəˈɹɪstɪk/, pharmaceutical /ˌfɑː.məˈs(j)uː.tɪ.kl̩/, sensitivity /ˌsɛn.səˈtɪv.ə.ti/, intangible /ɪnˈtæn.d͡ʒə.bəl/
How to practise with this video
- Listen to the whole video once without speaking and note the words you do not know.
- Shadow it sentence by sentence at normal speed, repeating each one until your rhythm matches the speaker.
- Record yourself and compare with the original, paying attention to words like webinar, payer, calculate.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.