CCE VLE Resource Allocation Flashcards
What are some of the values that inform resource allocation decisions?
(made by NHS citizen’s council 2014)
Utilitarianism - maximising total benefit for most
Right to health and welfare for all (individual rights and humanity)
Safeguarding of vulnerable
Value/quality of the service
QOL
Respect and dignity
Justice and fairness
Accountability and collective responsibility
Honesty
Education
What are some of the relevant ethical principles and values for resource allocation in healthcare?
-
Maximising overall benefit -utilitarianism
- underlies the QALYs approach
-
Respect for autonomy
- facilitating choice within prescribed options
- public involvement within the decision making process
-
Responding to need
- rule of rescue (focus on identifiable individuals in immediate danger)
-
Equity or fairness
- allocating resources in proportion to need whilst acknowledging the needs of everyone
What is the difference between health inequality and health inequity?
Health inequality –> describes differences in health experiences and health outcomes between different population groups. According to SE status, gender, race/ethnicity/ age, disability or geographical area.
Health inequity –> describes differences in opportunity for different population groups which result in unequal life chances, access to health services, housing, nutritious food etc. These can lead to health inequalities.
How can we reduce health inequality?
To reduce health in equality we may need unequal distribution of healthcare services.
What is “proportionate universalism?”
What does it aim for?
Proportionate universalism refers to the delivery and resourcing of healthcare services of a scale and intensity proportionate to the degree of need.
Proportionate universalism aims to:
- improve the health of the whole population
- across the social gradient
- whilst simultaneously improving the health of the most disadvantaged fastest.
What is the ethical importance of process in decision making?
- Process in decision making is to ensure fairness:
- reasons agreed by all stakeholders as relevant and reasonable
- allows consistency of reasoning
- transparency of decision making
- opportunity for appeal/ review
What is John Rawls “veil of ignorance” and how does this relate to resource allocation?
- The veil of ignorance = a theoretical perspective in which we do not know how well off in society we will be, when we are making decisions about what would be fair for society
- Rawls suggested that fair allocation of resources will mirror whatever we choose under the veil of ignorance
- If our position in society is unknown we will allocate resources in the fairest possible way
Resourcing of healthcare in the UK
Where does funding come from?
What is the problem?
- Funding for the NHS comes from general taxation
- Around 197.4 billion of the annual budget (89%) is spent on the NHS
- 9.6% of GDP
- around £3000 per head of population
There is great financial burden on the NHS –> cannot meet the need/ demand for service
Therefore decisions are needed on where to allocate resources
What is the Role of NICE in resource allocation?
- Technology appraisals –> appraisal of new drugs, procedures, techniques. If supported the NHS is obliged to provide within 3 months. Only 51% recommended
- Guidelines –> guidelines only, but can inform clinical and purchasing decisions
- NICE is responsible for the synthesis of evidence to inform resourcing decisions made by commissioning groups.
- Allows appraisal of the value for money of a treatment/ procedure which is crucial part of decision making but not the only consideration.
What is the meaning of the following terms related to health economics?
Cost benefit
Cost minimisation
Cost consequence
Cost effectiveness
Cost utility
Cost benefit –> costs and benefits are expressed in monetary units e.g. do i take ibuprofen for my migraine now to avoid the need for more expensive sumatriptan later?
Cost minimisation –> two equal treatments, compares costs of the alternatives (e.g. sumatriptan vs more expensive rizatriptan
Cost consequence –> costs in monetary units vs consequence in natural units e.g. sumatriptan vs ibuprofen for my headache, sumatriptan is more expensive but better.
Cost effectiveness –> ratio of cost in monetary units and consequences in natural units e.g cost to time of pain relief, e.g. fast acting more expensive ibuprofen vs normal and cheaper ibuprofen. Cost per minute of pain avoided.
Cost utility –> ratio of costs in monetary units vs overall measure of health status –> cost per year of healthy life. Allows comparisons between treatments for different disorders.
What is health economic term is preferred by NICE?
What does this approach allow?
What is it measured in?
Cost utility is preferred by NICE
Allows comparison between treatments for different disorders
Measured in Qulity Adjusted Life Year (QALY)
- Uses the incremental cost effectiveness ratio/ incremental cost utility ratio (ICER/ICUR)
The cost is in monetary units of buying one year of life in perfect health.
What is health utility?
How can it be measured?
What is preferred by NICE in RCT’s?
What dimensions are involved in this method?
Health utility is a measure of the current overall health status or QOL.
It can be measured in different ways, within RCT;s EuroQol-5D is the brand leader. With a self completed questionnaire - preferred by NICE.
There are 5 dimensions of the Euro Qol 5D:
Mobility
self care
usual activities
pain / discomfort
anxiety/ depression
What is the preferred method of NICE for measuring COST vs QOL?
QALY’s - quality adjusted life years
Allows comparison between treatments for different disorders
Measured in Cost per Quality Adjusted Life year
= cost in monetary units of buying one year in perfect health.
Using Cost/QALY
5 years of life at 100% QOL is equivalent to how many years of life at half of that?
5 years at 100 % QOL = 10 years at 50% QOL
What calculating the gain in QALY’s where is the evidence from?
- RCT’s –> measure the EuroQOL-5D-5L at baseline and follow up after the intervention.
- Score of 1.0 = perfect health, score of 0 = state equal to death
- The range is from -0.281 to + 1 –> recognises a state worse than death
- Measure the difference in area under the curve
- If No ECT’s –> use economic modelling
Why is there uncertainty around NICE estimated of the incremental cost effectiveness of treatments?
Uncertainty as values are not expressed as statistical significance - e.g. 95% CI or P value.
They are expressed as a probability of being cost effective at a willingness to pay threshold.
