Block 15 Flashcards

1
Q

Most basic and simple form of economic evaluation

A

Cost minimisation analysis (CMA)

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2
Q

Assumption of cost minimisation analysis (CMA)

A

assumes thats health effects in each of the different alternatives are equal

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3
Q

When is CMA - cost minimisation analysis appropriate?

A

when prior evidence suggests there is no difference in outcomes between the alternatives being evaluated

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4
Q

What’s the decision rule in CMA

A

pick the least cost option

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5
Q

Advantages + disadvantages of cost-effectivenes analysis evaluation

A

ADVANTAGES
- Straightforward to carry out as simplistic and easily understood

  • clinicians familiar w outcomes measured as it uses clinically meaningful units

DISADVANTAGES

Narrow, uni-dimensional measure of effect

and therefore…..

cannot compare alternatives measured in different units

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6
Q

Threshold value

A

the amount of money we’re willing to spend in order to generate 1 unit of health gain

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7
Q

when might cost utility analysis be helpful?

A

when the effects of an intervention are multidimensional

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8
Q

Advantages and disadvantages of CUA

A

ADVANTAGES:

CUA enables comparison of interventions that would be measured using different clinical outcomes

Enables a global health budget to be allocated more efficiently across different clinical areas

DISADVANTAGES:

Is heavily reliant on the Quality Adjusted Life Year

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9
Q

Advantages + disadvantages of CBA

A

ADVANTAGES
Allows comparison across programmes with different health outcomes

Allows comparisons with non-health care interventions, so can be used to allocate a global budget

Overall public sector efficiency needs a standardised price per unit of outcome that funders are willing to pay. e.g. transport safety versus health care

DISADVANTAGES
How do we value a life?

Ethical problems, reluctance to place such values

How do we value a health outcome?

How do we measure and value other societal costs, e.g. time?

Difficulties mean very few CBAs are undertaken

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10
Q

What’s the preferred choice of economic evaluation in the UK?

A

CUA - cost utility analysis

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11
Q

Resource allocation decisions can occur at:

A

the macro - strategic or societal lvl

micro or clinical or individual patient level

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12
Q

Explain the ‘fair innings’ argument in terms of age-based resource allocation

A

Older people have had a full life and younger people have not therefore it’s much fairer to divert resources from older pts. to younger pts.

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13
Q

What do QALYs - based assessments involve?

A
  • assign utility value btwn 0-1 to a state of health

- AND then multiplying that value by the number of years expected to be lived in that sate

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14
Q

Write on white board briefly clinical pictures of common food poisoning causative agents

A

use Josie’s notes to check

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15
Q

Public Health Act in relation to food poisoning

A

allows exclusion of ppl from work/school etc. who pose increased risk of GI infection spread

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16
Q

In the procedure of Hazard analysis critical control point you need to:

A

 Analysis of the potential food hazards in a food business (e.g. microbiological, chemical & foreign matter contamination).

 Identification of the points in the operations where such hazards could occur.

 Deciding which of the identified points are critical to food safety (critical points).

 Identifying and implementing effective control and monitoring procedures at the critical points.

 Reviewing the hazards and critical points at periodic intervals and particularly when any change occurs to the operation.

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17
Q

What might outbreak outliers represent?

A

 Baseline level of illness

 Outbreak source

 A case exposed earlier than the others

 An unrelated case

 A case exposed later than the others

 A case with a longer incubation period

18
Q

Reverse causality

A

risk factor associated w an outcome AND tht outcome itself then leads to the development of another potential risk factor tht is then incorrectly associated w the outcome

19
Q

Residual confounding

A

the distortion that remains after controlling for confounding in the design and/or analysis of a study

20
Q

Cost-outcome description

A
  • Not comparing 2 or more alternatives

- examines cost+ consequences

21
Q

Outcome description (partial evaluation)

A
  • Not comparing 2 or more alternatives

- examines consequences only

22
Q

Cost description (partial evaluation)

A
  • Not comparing 2 or more alternatives

- examines COST ONLY

23
Q

Comparing 2 or more alternatives but only examining consequences

A

Effectiveness analysis (partial evaluation)

24
Q

Comparing 2 or more alternatives but only examining cost

A

Cost analysis (partial evaluation)

25
Synthetic economic evaluations rely on what type of data?
secondary or existing data
26
TARs
Technology assessment reviews for NICE => way of conducting economic evaluation using secondary data
27
Give an example of a narrow perspective of costs in terms of EE
looking at costs to NHS only
28
ICER
Incremental cost effectiveness ratio | C intervention - Cost control) / (E intervention - E control
29
Graphical representation of ICERs
=> cost-effectiveness plane
30
Ceiling ratio
level of the ICER which any alternative must meet if it is too be regarded as cost-effective
31
EE that uses cost per QALY as a means of ranking alternatives
CUA - cost utility analysis
32
What is the aim of QALY league tables?
to achieve EFFICIENCY by purchasing lowest cost/QALY option til all healthcare budget exhausted BUT may not be most equitable as some individuals may need option w highest cost per QALY
33
Advantages of CBA
allows comparison across programmes with different health outcomes allows allocation of global health budget as you can compare non-healthcare interventions
34
What can reminder systems be used for?
To remind clinicians about: - screening - medication use - vaccinations - testing - identification of risk behaviour e. g. Systemone
35
Aim of Wells score
Type of diagnostic system aim is to reduce no. of unnecessary D-dimer tests + indicate management of VTE
36
Diagnostic system that might be used to reduce number of unnecessary X-rays
Ottawa ankle rules
37
How can 'prescribing systems' aid clinical DM?
- provide advice on drug dosage - advice on drugs to prescribe - highlight potential drug interactions
38
Summarise evidence for use of prescribing systems:
doctors tended to prescribe high initial doses tht help reduced the amount of time patients spent in hospital
39
When using decision support, what aspects are improved in clinical practice?
- improved clinician workflow - improved support regarding disease management - timely decisions as it provided decision support when and where decision making was happening
40
Barriers and facilitators to CDSS use
BARRIERS - Negative experience of IT - Potential harm to doctor-patient relationship - Obscure responsibilities of autonomy/reasoning FACILITATORS - Self-control of CDSS - If clinician can notice help in practice
41
What are patient decision aids?
interventions designed to help ppl. make specific + deliberative choices among options available by providing info on options + outcomes relevant to a person’s health status
42
Aim of patient decision aids:
To help patients to: - UNDERSTAND likely outcomes of options by providing info relevant to the decision - Consider the PERSONAL VALUE they place on benefits vs harm, by helping clarify preferences - Feel SUPPORTED in decision making - Move through the steps in making a decision - Participate in decision about their health care (autonomy)