Block 15 Flashcards
Most basic and simple form of economic evaluation
Cost minimisation analysis (CMA)
Assumption of cost minimisation analysis (CMA)
assumes thats health effects in each of the different alternatives are equal
When is CMA - cost minimisation analysis appropriate?
when prior evidence suggests there is no difference in outcomes between the alternatives being evaluated
What’s the decision rule in CMA
pick the least cost option
Advantages + disadvantages of cost-effectivenes analysis evaluation
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
Threshold value
the amount of money we’re willing to spend in order to generate 1 unit of health gain
when might cost utility analysis be helpful?
when the effects of an intervention are multidimensional
Advantages and disadvantages of CUA
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
Advantages + disadvantages of CBA
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
What’s the preferred choice of economic evaluation in the UK?
CUA - cost utility analysis
Resource allocation decisions can occur at:
the macro - strategic or societal lvl
micro or clinical or individual patient level
Explain the ‘fair innings’ argument in terms of age-based resource allocation
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.
What do QALYs - based assessments involve?
- 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
Write on white board briefly clinical pictures of common food poisoning causative agents
use Josie’s notes to check
Public Health Act in relation to food poisoning
allows exclusion of ppl from work/school etc. who pose increased risk of GI infection spread
In the procedure of Hazard analysis critical control point you need to:
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.
What might outbreak outliers represent?
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
Reverse causality
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
Residual confounding
the distortion that remains after controlling for confounding in the design and/or analysis of a study
Cost-outcome description
- Not comparing 2 or more alternatives
- examines cost+ consequences
Outcome description (partial evaluation)
- Not comparing 2 or more alternatives
- examines consequences only
Cost description (partial evaluation)
- Not comparing 2 or more alternatives
- examines COST ONLY
Comparing 2 or more alternatives but only examining consequences
Effectiveness analysis (partial evaluation)
Comparing 2 or more alternatives but only examining cost
Cost analysis (partial evaluation)
Synthetic economic evaluations rely on what type of data?
secondary or existing data
TARs
Technology assessment reviews for NICE => way of conducting economic evaluation using secondary data
Give an example of a narrow perspective of costs in terms of EE
looking at costs to NHS only
ICER
Incremental cost effectiveness ratio
C intervention - Cost control) / (E intervention - E control
Graphical representation of ICERs
=> cost-effectiveness plane
Ceiling ratio
level of the ICER which any alternative must meet if it is too be regarded as cost-effective
EE that uses cost per QALY as a means of ranking alternatives
CUA - cost utility analysis
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
Advantages of CBA
allows comparison across programmes with different health outcomes
allows allocation of global health budget as you can compare non-healthcare interventions
What can reminder systems be used for?
To remind clinicians about:
- screening
- medication use
- vaccinations
- testing
- identification of risk behaviour
e. g. Systemone
Aim of Wells score
Type of diagnostic system
aim is to reduce no. of unnecessary D-dimer tests + indicate management of VTE
Diagnostic system that might be used to reduce number of unnecessary X-rays
Ottawa ankle rules
How can ‘prescribing systems’ aid clinical DM?
- provide advice on drug dosage
- advice on drugs to prescribe
- highlight potential drug interactions
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
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
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
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
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)
