Block 15

Question 1

Most basic and simple form of economic evaluation

Answer 1

Cost minimisation analysis (CMA)

Question 2

Assumption of cost minimisation analysis (CMA)

Answer 2

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

Question 3

When is CMA - cost minimisation analysis appropriate?

Answer 3

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

Question 4

What’s the decision rule in CMA

Answer 4

pick the least cost option

Question 5

Advantages + disadvantages of cost-effectivenes analysis evaluation

Answer 5

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

Question 6

Threshold value

Answer 6

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

Question 7

when might cost utility analysis be helpful?

Answer 7

when the effects of an intervention are multidimensional

Question 8

Advantages and disadvantages of CUA

Answer 8

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

Question 9

Advantages + disadvantages of CBA

Answer 9

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

Question 10

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

Answer 10

CUA - cost utility analysis

Question 11

Resource allocation decisions can occur at:

Answer 11

the macro - strategic or societal lvl

micro or clinical or individual patient level

Question 12

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

Answer 12

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.

Question 13

What do QALYs - based assessments involve?

Answer 13

• 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

Question 14

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

Answer 14

use Josie’s notes to check

Question 15

Public Health Act in relation to food poisoning

Answer 15

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

Question 16

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

Answer 16

 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.

Question 17

What might outbreak outliers represent?

Answer 17

 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

Question 18

Reverse causality

Answer 18

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

Question 19

Residual confounding

Answer 19

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

Question 20

Cost-outcome description

Answer 20

• Not comparing 2 or more alternatives

- examines cost+ consequences

Question 21

Outcome description (partial evaluation)

Answer 21

• Not comparing 2 or more alternatives

- examines consequences only

Question 22

Cost description (partial evaluation)

Answer 22

• Not comparing 2 or more alternatives

- examines COST ONLY

Question 23

Comparing 2 or more alternatives but only examining consequences

Answer 23

Effectiveness analysis (partial evaluation)

Question 24

Comparing 2 or more alternatives but only examining cost

Answer 24

Cost analysis (partial evaluation)

Question 25

Synthetic economic evaluations rely on what type of data?

Answer 25

secondary or existing data

Question 26

TARs

Answer 26

Technology assessment reviews for NICE => way of conducting economic evaluation using secondary data

Question 27

Give an example of a narrow perspective of costs in terms of EE

Answer 27

looking at costs to NHS only

Question 28

ICER

Answer 28

Incremental cost effectiveness ratio

C intervention - Cost control) / (E intervention - E control

Question 29

Graphical representation of ICERs

Answer 29

=> cost-effectiveness plane

Question 30

Ceiling ratio

Answer 30

level of the ICER which any alternative must meet if it is too be regarded as cost-effective

Question 31

EE that uses cost per QALY as a means of ranking alternatives

Answer 31

CUA - cost utility analysis

Question 32

What is the aim of QALY league tables?

Answer 32

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

Question 33

Advantages of CBA

Answer 33

allows comparison across programmes with different health outcomes

allows allocation of global health budget as you can compare non-healthcare interventions

Question 34

What can reminder systems be used for?

Answer 34

To remind clinicians about:

• screening
• medication use
• vaccinations
• testing
• identification of risk behaviour
  e. g. Systemone

Question 35

Aim of Wells score

Answer 35

Type of diagnostic system

aim is to reduce no. of unnecessary D-dimer tests + indicate management of VTE

Question 36

Diagnostic system that might be used to reduce number of unnecessary X-rays

Answer 36

Ottawa ankle rules

Question 37

How can ‘prescribing systems’ aid clinical DM?

Answer 37

• provide advice on drug dosage
• advice on drugs to prescribe
• highlight potential drug interactions

Question 38

Summarise evidence for use of prescribing systems:

Answer 38

doctors tended to prescribe high initial doses tht help reduced the amount of time patients spent in hospital

Question 39

When using decision support, what aspects are improved in clinical
practice?

Answer 39

• improved clinician workflow
• improved support regarding disease management
• timely decisions as it provided decision support when and where decision making was happening

Question 40

Barriers and facilitators to CDSS use

Answer 40

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

Question 41

What are patient decision aids?

Answer 41

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

Question 42

Aim of patient decision aids:

Answer 42

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)