Cost Utility Analysis

Question 1

What does CUA measure?

Answer 1

Measures costs in dollars ($$$) & outcomes in health utilities (i.e., QALY or quality-adjusted life year)

Question 2

What is QALY?

Answer 2

Heath utility that accounts for the patients quality and quantity of life
* Years of life are adjusted by utility weights ranging from 0-1
* Utility weights are assigned based on patient or societal preferencces for certain disease states

Question 3

What are the advantages of CUA?

Answer 3

1. Multiple health outcomes can be compared using one common unit (QALYs) without assigning monetary value
2. CUA should be used when morbidity and mortality are important health outcomes associated with a treatment

Question 4

What are the disadvantages of CUA?

Answer 4

Difficult to determine an accurate QALY value

Question 5

What are the steps of calculating QALYs?

Answer 5

1. Develop a descrioption of each disease state or condition of interest
2. Choose a method for determining utilities
3. Choose subjects who will determine utilities
4. Multiply the utility scores by the length of life for each option to obtain QALYs

Question 6

How do you Develop a description of each disease state or condition of interest?

Answer 6

1. Concisely describe the usual health effect associated with a disease state
2. Include elements of a certain disease state or medical condition

Question 7

What are the elemetns of certain disease state or condition?

Answer 7

1. Amount of pain and discomfort
2. Restrictions on normal daily activities
3. Time necessary for treatment
4. Possible changes in health perception
5. Mental health changes

Question 8

What are exampoles of Developing a description of each disease state or condition of interest.

Answer 8

1. Hospital based kidney dialysis
2. Diabetic retinopathy

Question 9

What are common methods for determining utility weights?

Answer 9

1. Rating scale
2. Standard gamble
3. Time tradeoff

Question 10

What is a rating scale?

Answer 10

1. One line on a page with scaled marking from 0-100
2. Subjects receive descriptions about different disease states or conditions
3. Subjects rate their estimated preferences on the rating scale

Question 11

What are the advantages of a rating scale?

Answer 11

1. Describes multiple disease states in one RS eval
2. Preformed remotely via questionnaire
3. General public’s familiarity with rating preferences

Question 12

What are the disadvantages of RS?

Answer 12

1. Dont incorporate time into utility score, when compared to SG or TTO
2. Posible bias in preferences
   * Tendency not to rate utility near 0 or 1
   * Tendency to rate preferences throughout given range
3. Participants dont rank preference choices between options

Question 13

What is a standard gamble?

Answer 13

Method where participants offter alternatives:
1. Alternative 1: treatmetn with 2 potential results of retunring to normal or immediate death
2. Alternative 2: certain outcomes of disease state for life based on life expectancy

Probability of normal health measured by p
Immediate death measured by 1-p
Probability of normal health is varied unntil participants reach a point of indifference between alternatives 1 and 2

Question 14

What are the advantages of SG?

Answer 14

Gold standard method on economic theory

Question 15

What are the disadvantages of SG?

Answer 15

1. Difficult for participants to complete (more cognitively demanding than RS)
2. Appropriate only to administer in face-to-face matter (necessary to ask reptitive questions, requires resources)

Question 16

What is time tradeoff?

Answer 16

Alternative 1: specific disease state for specific length of time (t)
* Time (t) = life expectancy of a patient with the specific disease state

Alternative 2: being healthy for time x, which is less than t

Question 17

How do you calculate a utility score?

Answer 17

Utility score = 𝑥/𝑡

Question 18

What are the advantages of TTO?

Answer 18

1. More adaptable to disease state than SG method
2. Uses time in the disease state more easilty than RS method

Question 19

What are the disadvantages of TTO?

Answer 19

1. Difficult for patients to complete
   * More cognitively demanding than RS method
2. Appropriate only to adminsiter in face to face matter
   * Necessary to ask repetitive questions
   * Requires more resources to perform, when compared to RS questionnaire

Question 20

What are the advantages and disadvantages of choosing patients with specifc diseases to determine utilities?

Answer 20

Advantages: Better understand effects of disease
Disadvantages: potential bias when rating preferences for specific disease

Question 21

Patient with specific disease rate ___ utility scores than general public because?

Answer 21

Higher due to patients’ adaptability & adjustments for living with disease

Question 22

Who determines utility scores for patients?

Answer 22

Caregivers

Question 23

What are the advantages and disadvantages of choosing healthcare providers to determine utilities?

Answer 23

Advantages:
* Good understanding about numerous disease states
* Easily accessible for interviews

Disadvantages:
* Potential bias not to rate pain, discomfort or disability lower on preferences, when compared to patients’ rating

Question 24

What are the disadvantages of choosing society providers to determine utilities?

Answer 24

1. Lack of familiarity with effects associated with a specific disease
2. Descriptions of specific diseases may not cover all issues associated with the condition
3. More time & labor demanding
4. More cognitively demanding on general public, if all issues associated with condition are discussed in the description

Question 25

What is should society be used to determine utilities?

Answer 25

If societal perspective is used in the study, economists argue that utility scores should be determined by our society.