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Econ Exam 2 Flashcards

1
Q

Cost Utility Analysis (CUA)

A

measures cost in dollars and outcomes in quality adjusted life year (QALY)
-known as a subset of CEA
-outcomes in natural health units
takes patients preferences or satisfaction (utilities) into account

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2
Q

Quality of Life

A

evaluation of all aspects of our lives including where we live, how and how we play and how we work

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3
Q

health-related quality of life

A

only those aspects of life that are dominated or significantly influenced by personal health or activities performed to maintain health

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4
Q

Genetic Instruments

A

Health status measures
preference based measures (utility measures)

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5
Q

Specific Instruments

A

Disease specific
population specific
function specific
condition specific

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6
Q

QALY

A

a measure of value and benefit of health outcomes
incorporates both the quantity (mortality,death) and quality (morbidity:disease states)

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7
Q

Why measure Utility?

A

patient satisfaction is related to financial implications
-patient choice of health plans
-patient recommendation to other patients
-malpractice claims

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8
Q

Why measure Utility? part 2

A

-Patient satisfaction is related to clinical implications
-patients desire to adhere to providers directions, appointments and comply with treatments

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9
Q

characterisitics of utility measurement

A

subjective, individualized, personal, a room for biases

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10
Q

Biases for self assessment

A

acquiescence-tendency to agree with any item
extremity:tendency to respond to highest/lowest response alternative
evasiveness-tendency to respond to middle alternative
carelessness: tendency to respond randomly or thoughtlessly to items
social desirability-tendency to respond in a conventional rather than truthful way

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11
Q

QALY calculation

A

Utility X Years of life

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12
Q

Methods to determine utilities

A

rating scale, standard gamble, time tradeoff

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13
Q

rating scale

A

a line with scaled markings (thermometer)

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14
Q

Adavantages of CUA

A

multiple outcomes can be compared (unlike CEA)
Incorporates mortality and morbidity into once unit of QALY without having to estimate monetary value of health outcomes

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15
Q

Disadvantages of CUA

A

difficulty in measuring accurate QALY/utility
Utility measurement is not a precise or scientific measurement
-CUA less commonly used

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16
Q

CUA is a pharmaeconomic analysis that measures costs in dollars and quality adjusted life year

A

True

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17
Q

utility score is?

A

the point where 2 options are nearly equal and you cannot decide between the 2

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18
Q

Acquiescence

A

always agree with any item, regardless of the content of the question

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19
Q

Extremity

A

tendency to respond to the highest or lowest response alternative

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20
Q

Evasiveness

A

tendency to respond to the middle alternative

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21
Q

Carelessness

A

tendency to respond randomly or thoughtlessly

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22
Q

Social Desirability

A

tendency to respond in a conventional rather than truthful ways or when subjects want to be perceived as a good patient

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23
Q

Cost-Benefit Analysis

A

compares both costs and benefits (outcomes) in monetary units
-used to aid public policy (government uses for economic welfare)

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24
Q

What is CBA used for now?

A

irrigation and flood control, wildlife, air quality
A vaccination program for children

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25
Advantages of CBA
many different outcomes-can compare multiple programs can determine which program has the greatest benefit
26
disadvantages of CBA
can lead to biased or inaccurate estimates of the outcomes
27
Cost Components of CBA
Direct medical Direct non-medical
28
Benefits of CBA
Direct medical Direct non-medical Indirect: HC (human capital), WTP (willing to pay) Intangible: WTP
29
CBA: Direct medical cost Ex:
Cost to visit pharmacy for asthma program -Spend $100 for asthma program
30
CBA: Direct medical benefit
Benefit of reduction in the number of ER visit -Save $2,000 to visit ER
31
Indirect Benefits-Human Capital (HC) Method
Increases (prevents the decrease) in productivity or earnings because of a program Calculate: Wage rate and missed time (days or years)
32
HC Wage (income) and Missed time
-Uses income sources such as: -census bureau -Bureau of labor and stats -self-report (paycheck) -Includes fringe benefits-health insurance and life insurance paid can use self report for missed days or years
33
HC has 2 types of wages?
A yearly wage rate (annual income) A daily wage rate
34
A yearly wage rate used when?
Used for a program that would reduce long-term disability or death -like a pneumococcal program
35
A daily wage rate used when?
Used for a program targeted at an acute chronic illness with short-term disability -like episodes of asthma attacks
36
HC Disadvantage
Personal Wage differences-people say it should be based off the average population and not the specific patients -Does not consider health related quality of life such as pain and suffering. Ex: menopause, headache, sore muscle
37
WTP-Willingness to pay method
to determine how much people are willing to pay to reduce the chance of an adverse health outcome -incorporates patient preferences and intangible benefits
38
WTP Contingent Valuation (CV)
The respondents are asked to value a contingent or hypothetical intervention in dollar values asked to value health care intervention in $$$
39
2 components of WTP
1. Hypothetical Scenario 2. Bidding Vehicles
40
Hypothetical Scenario includes:
a description of health care programs or intervention amount of time the person should expect to spend benefits the person should expect -provides an accurate description
41
Bidding Vehicles include:
-Open ended questions -Closed ended questions -bidding games -payment card
42
Open ended questions
-Used the least because of wide range of values or what values to put in
43
closed ended questions
uses only one WTP value take it or leave it (Yes or No)
44
bidding games
several bids (usually 3 times) to reach a persons max wtp time consuming starts point bias If Yes, ask another question regarding price
45
payment card:
provides a list of possible WTP amounts to choose from (usually from a table) very easy and provides a range of values at the same time introduces range bias: suggestion of values leads to influence
46
2 ways to present CBA:
Net benefit or net cost=subtraction benefit to cost ratio or cost to benefit ratio=division
47
net benefit=
total benefits - total costs
48
net cost=
total costs - total benefits
49
cost beneficial if?
net benefit >0 or net cost <0
50
benefits to cost ratio
total benefits/total costs
51
cost to benefit ratio
total costs/total benefits
52
Ratio-cost beneficial when?
Benefit to Cost >1 or Cost to benefit <1
53
Choose IRR (internal rate of return) if:
IRR > than the hurdle rate ->accept the project
54
Humanistic Outcomes
patient reported outcome (PRO) -comes directly from the patient without amendment or interpretation measured by self-report or by interview of only patients response
55
HRQoL
overall quality of life that is health related perceived by the patient -it distinguishes health outcomes from financial status, family life, friendships, job satisfaction
56
Importance of HRQoL
WHO: health is a state of complete physical mental and social well being and not merely the abscense of disease or infirmity
57
3 methods to measure health states
1. utility measures 2. HRQoL Measures 3. preference based classification
58
Utility measures
preference based or choice based Uses the standard gamble and time tradeoff time consuming and resource intensive
59
HRQoL Measures
non-utility or non-preference surveys are multidimensional (multiple concepts) and do not result in once score -complicates interpretation
60
2 ways to measure HRQoL
1. General/Generic Measures 2. Disease-specific measures combo of both is recommended
61
General measures
generic measures: SF-36 SF-12 scores compared for many diseases may not be sensitive to differences for every disease
62
disease specific measures
condition specific measures physical symptoms distress index living with asthma questionnaire -more narrow on patients views cannot compare across pops.
63
SF36
most common generic HRQoL instrument used in US self evaluation of change in health during past year includes questions on: pain, emotional, physical, limitations, social activities, energy and emotions
64
4 dimensions of HRQoL?
1. physical functioning 2. psychological (mental) functioning 3. Social/Role functioning 4. General Health perception
65
3 instruments of HRQoL?
1. reliability 2. validity 3. responsiveness
66
physical functioning?
observable limitations or disability -energy level, bodily pain, activities of daily living
67
physcological (mental) functioning?
Psychological distress -anxiety, depression, moodiness, life satisfaction, cognitive function
68
social functioning?
maintain social relationships like social interactions
69
role functioning?
duties and responsibilities that are limited due to health like working, school or household duties
70
general health perception
patients overall beliefs and evaluations related to both patients perception on current health and future expectations
71
Reliabillity?
consistency o same score on multiple administration? like test-retest, internal consistency, interrater
72
reliability: test-retest
similarity of health status over time when no changes occur
73
reliability: internal consistency
assess correlation (agreement) between responses to questions within the same domains like vitality: physically tired or worn out?
74
Reliability: Interrater
the correlation between 2 respondents of health status like asking both mother and teacher
75
T or F: all valid tests are reliable
True
76
T or F: A reliable test may or may not be valid
True
77
validity
true representation
78
validity: content
face validity if HRQoL offers adequate representation of the relevant variables complete and relevant
79
Validity: Criterion
predictive validity correlate with or predict health outcomes
80
High HRQoL scores predict?
less use of medical services
81
Low HRQoL scores predict?
higher rates of mortality
82
Validity Construct
Convergent, discriminant, known-group
83
validity: Construct-convergent
determines whether use of different measures of the same construct provide similar results ex: scores of mental health should be similar to scores of disease specific scores like bipolar
84
validity: Construct-discriminant
if different measures and their constructs can be differentiated from others EX: physical functioning is NOT expected to be highly related to mental functioning
85
Validity Construct-known-group
determines differences between patient groups known ex: anxiety-first time mothers vs women already given birth
86
Responsiveness
captures information on change in health states -Minimally important difference used (MID)
87
MID:
smallest change or difference in an outcome measure that is perceived as beneficial and would lead to change in patients medical management
88
preference based classification
a hybrid of the utility and HRQoL measures -uses utility but based on math using predeveloped instruments -less resource intensive
89
common domains measure in health care services
clinicians scientific knowledge quality of clinician patient communication provision of humane interpersonal treatment degree of patients trust
90
Decision Analysis
compares different decision options graphically displays choices helps with selecting best or most cost effective option
91
Step 1: identify specific decisions
-good study design objective of study, decision makers, perspectives, period of time
92
step 2: specify alternatives
new therapy vs standard can compare more than 2 treatments
93
step 3: draw the decision tree
branches, nodes are where the different options occur choice node: square and is allowed chance: circle terminal: triangle and the final outcome is determined
94
step 4 estimates:
specify costs, outcomes and probabilities
95
ICER formula
C1-C2 / E1 - E2
96
Markov Modeling
analyzes more complex outcomes and longer follow up periods
97
transition
patients may move between health states over periods of time
98
cycle (interval)
time period that is determined to be relevant to the specific disease or condition
99
absorbing state
when patients cannot move to another health state (dies)
100
Pharmaceutical services
functions done by a pharmacist that may or may not be associated with dispensing a particular prescription
101
pharmacy service programs
clinical, cognitive, pharmaceutical, disease state, MTM (ALL OF THE ABOVE)
102
PE study for pharmacy services
to determine whether the service is worthwhile financially CBA is the most common to use
103
Silo Mentality
only one budget or silo (pharmacy budget) non-pharmacy health care costs such as ER and hospital can decrease because of better med management
104
Budget Impact Analysis (BIA)
Technology! to understand affordability of the new health care tech. financial statements with or without new health care tech.
105
primary cost component is?
acquisition costs costs of admin and monitoring and costs to treat AE
106
changes in disease related costs
can occur within time horizon (can offset new tech costs) or outside time horizon
107
costs of tech presented on?
annual basis
108
CUA is a subset of?
CEA
109
CUA measures
quantity (mortality: death) and quality (QUALY)
110
standard gamble: Alternative 1
YOU receive an intervention and can Die or be Healthy
111
standard gamble: Alternative 2
YOU receive no intervention
112
Choose Operation: point of indifference (use when not sure when to go with surgery) becomes the
UTILITY score
113
If patient has 85% chance of living and 15% dying and wants to do the surgery: Is the Utility score 0.85 (True or False):
False there is no utility score since patient still chose an option (no point of indifference)
114
Time trade off (choose to be healthy), calculate utility score?
point of indifference / time

Biostats (4 decks)

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