Costing out Care

As a health economist, Dr. Shweta Mital is constantly aware of the tension between the need for innovation in health care and the costs that innovation brings.

“There are always new technologies, new drugs, new devices coming to market – some of them quite expensive,” says Mital, who recently joined the College of Pharmacy as an assistant professor in pharmacoeconomics.

“We need to ensure we get the best value for our health-care dollars. If the health system is spending more on new technologies or drugs, then it has less to spend on something else.”

Mital’s economic studies have been published in a wide variety of health journals, in subject areas such as respirology, cancer, AIDS, diabetes and gastroenterology.

One of her studies focused on asthma patients, quantifying how better day-to-day control of the disease results in health-system cost savings, such as fewer doctor visits.

Calculating the cost-effectiveness of new drugs is complex because researchers must consider factors such as downstream disease management costs and quality of life, Mital says. “For example, if a drug is expensive, but we know it will prevent later complications and hospitalizations, it may be worth the price.”

A study Mital published in 2020 in the journal Pharmacoeconomics measured the cost-effectiveness of the immunotherapy drug teplizumab. It’s the first drug approved in the United States – though not yet in Canada – to delay the onset of Type 1 diabetes by two to four years.

“It’s a game-changer for those at risk of Type 1 diabetes,” says Mital. “But are the benefits worth the high price? Will insurers cover it?”

Her study, published before the market price for teplizumab was set and using American dollars, showed that if the drug were priced above $194,000 per patient, teplizumab would not be cost-effective.

If priced between $88,000 and $194,000, it would be cost-effective only for patients with specific characteristics. To treat all at risk patients would be cost-effective only if the price were below $49,000 per patient.

In a country like Canada, universal health care means patients themselves don’t typically have to worry about the cost of one treatment over another. “But public and private insurance plans need to make reimbursement decisions,” Mital says. “That’s one of the areas my research can help to inform.”

Born in India, Mital earned her first two degrees in economics in Delhi and in Warwick, England. Then, while working as a research assistant in health economics at a medical school in Singapore, she started to combine her interest in economics with her curiosity about science.

“It’s gratifying to apply my economics skill set to health-care challenges,” she says.

She went on to complete a PhD and postdoctoral work in health economics at Memorial University of Newfoundland before joining UM in January 2023.

Among her planned projects here, she hopes to continue to study how future reimbursement policies for Type 1 diabetes treatments will affect health outcomes for patients.

“I’m excited about the opportunities to collaborate with leading researchers at the University of Manitoba,” she says.