CUA

Question 1

CUA is a type of ___

Answer 1

CEA

Question 2

what does CUA stand for

Answer 2

cost utility analysis

Question 3

what is CUA

Answer 3

a type of CEA in which benefits are expressed as the number of life years saved adjusted to account for loss of quality from morbidity of the health outcome or side effects from the intervention

Question 4

in a CUA, ____ are assigned to outcomes

Answer 4

values (utilities)

Question 5

where do you obtain utilities

Answer 5

literature
convenience sample
measure from society
measure directly from patients (direct approach is decision theory, indirect approach is psychometric method)

Question 6

how do we measure preferences?

Answer 6

direct: rating scale, standard gamble, time trade off

indirect: multi-attribute health status preference scores

Question 7

what is the gold standard for measuring preferences

Answer 7

standard gamble
because it is framed under the condition of uncertainty

Question 8

what is standard gamble

Answer 8

patients are asked to compare one option, whose outcome is to remain in the current state until death, with a second option that has an uncertain outcome.

probabilities are varied until the subject is indifferent to either treatment

Question 9

what is time-trade off

Answer 9

used to determine how many years of life in excellent health are equivalent to life with a less desirable health state

time is varied until the individual is indifferent about the alternatives

Question 10

what is multi-attribute health status preference score

Answer 10

measures how the general public values a given health state. combines different dimensions of health to compute a series of health preference values
(psychometric methods)

Question 11

utility is a measure of ____

Answer 11

preference for a particular health state

Question 12

what is QALY

Answer 12

quality adjusted life year

health utility measure which combines quality of life with life years gained

Question 13

how do you calculate QALY

Answer 13

calculate AUC

Question 14

when should quality be measured?

Answer 14

primary purpose of drug is palliative vs curative
drug somewhat effective but also fairly toxic
lifelong therapy administered to prevent complications of a relatively asymptomatic disease

Question 15

why should we measure quality

Answer 15

length of life is not that important if the quality is bad

Question 16

when do we know to use a CUA

Answer 16

when QOL is important outcome
intervention affects both morbidity & mortality
interventions compared have a wide range of different outcomes

Question 17

ICER in a CUA

Answer 17

uses qaly

ICER= (cost A- cost B)/ (QALY A-QALY B)

Question 18

strengths of CUA

Answer 18

integrates both quality & quantity of life into a common unit of measure: allows comparison of interventions on different dementions

Question 19

limitations of CUA

Answer 19

questions based solely on calculation of QALY
measured in years so not useful for acute conditions

Question 20

assumptions about QALYs

Answer 20

life and death are reference states (healthy 1, dead 0)
QALY only captures health-related utility
utility value of healthy life is set equal for each individual at birth
attributes of quality and quantity must be mutually independent

Question 21

one full healthy year of life is ___ QALY

Answer 21

1.0

Question 22

years of life in less than optimal health are scored ___ QALY

Answer 22

<1.0

Question 23

QALY limitations

Answer 23

-are many small improvements (0.1 QALY) really equal to one large improvement (1.0 QALY)?
-improvement from 0.1-0.5 is valued the same as 0.5-0.9 but is it really?

Question 24

two types of sensitivity analysis in CUA

Answer 24

one-way sensitivity analysis (OWSA)

probabilistic sensitivity analysis (PSA)

Question 25

OWSA

Answer 25

change one parameter of a time keeping all others constant: will tell you the most influential parameters to your model

Question 26

PSA

Answer 26

change all (or many) variables simultaneously