Ch 8

Question 1

◦Research methods have been developed to appraise, describe, and compare the relative value of health services. These are called…

Answer 1

cost-effectiveness analyses or economic evaluations

Question 2

Economic evaluations are distinct from clinical evaluations in that they..

Answer 2

focus on costs and outcomes rather than the efficacy or effectiveness of a specific intervention.

Question 3

Descriptive profile of the costs and outcomes of one or more interventions.

Answer 3

Cost-consequences

Question 4

Identifies the least costly alternative for services that result in equivalent outcomes.

Answer 4

Cost-minimization

Question 5

Describes and compares the relative costs and outcomes of two or more interventions that result in the same type of outcome.

Answer 5

Cost-effectiveness

Question 6

Describes and compares the relative costs and outcomes of two or more interventions in which the outcomes of interest include health status and the value of the status to the individual.

Answer 6

Cost-utility

Question 7

Describes and compares the relative costs and outcomes of two or more interventions in which both the costs and outcome can be measured in monetary values.

Answer 7

Cost-benefit

Question 8

Community based geriatric case management program for frail elderly.

Is an example of

Answer 8

Cost-consequence

Question 9

Use of hip protectors in the prevention of hip fractures in frail institutionalized elderly.

Is an example of…

Answer 9

Cost-Minimization

Question 10

Water-based exercise therapy versus usual care for lower limb osteoarthritis.
Home exercise program or no intervention for knee pain.

Is an example of…

Answer 10

Cost-Effectiveness

Question 11

Early discharge of elderly persons.
Stroke unit, stroke team, or domiciliary stroke care.

Is an example of…

Answer 11

Cost-Utility

Question 12

Needle exchange program to prevent HIV transmission.
Providing versus not offering a fall prevention program.

Is an example of…

Answer 12

Cost-benefit

Question 13

Conducting Economic Evaluations

Answer 13

Research question defines the purpose and scope of assessment.
◦Descriptive analysis or comparative assessment.
◦Important to consider the perspective of the analysis (from society, payers, providers, and/or consumers).
◦Evaluators of economic analyses should make judgments regarding the internal and external validity of their assessments including source of bias, contamination, and noncompliance.
◦When critically analyzing economic analyses, it is important to look at both internal and external factors

Question 14

Questions to ask with internal validity

Answer 14

Did the research question clearly/accurately define compared options? Was perspective of the analysis defined?
–Were the important costs and outcomes identified and properly measured and valued?
–How rigorous was the methodology used to establish costs and the effectiveness of service alternatives?
–Were differences between outcomes analyzed and compared?

Question 15

Questions to ask with external validity

Answer 15

Are the outcomes worth the costs?
–Could my clients expect similar health outcomes?
–Could I expect similar costs?

Question 16

Locating Economic Evaluations

Answer 16

Research can be found with traditional databases like MEDLINE and HealthSTAR.
◦National Health Service Centre for Reviews and Dissemination (University of York, UK) contains structured abstracts and critical appraisals of economic evaluations from 1994 (Web-based).
◦Health Economic Evaluations Database contains abstracts and structured reviews from 1967 (subscription).

Question 17

There are five different types of economic evaluation that have been defined in the literature:

Answer 17

1.Cost-consequences
2.Cost-minimization
3.Cost-effectiveness
4.Cost-utility
5.Cost-benefit analyses

Question 18

In order to inform consumers and clients about the relative value of specific health and rehabilitation services for defined clientele, we must:

Answer 18

1.Conduct evaluations to determine whether specific interventions are effective at attaining desirable outcomes

2.Evaluate effective interventions to ensure that they offer the most efficient means of attaining specific outcomes

3.Effectively communicate these results

Question 19

The intent and purpose of economic evaluations are to

Answer 19

provide clients and consumers with information regarding value in order to inform their decisions.

Question 20

Within the health care context, the term value refers to

Answer 20

the relative worth, utility, or importance of a service in meeting the health needs of a defined clientele

Question 21

For a service to be “valuable,” clients should…

Answer 21

receive a fair return (i.e., service and outcome) for something exchanged (i.e., finances and time invested)