Econ Exam 2 Flashcards
Cost Utility Analysis (CUA)
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
Quality of Life
evaluation of all aspects of our lives including where we live, how and how we play and how we work
health-related quality of life
only those aspects of life that are dominated or significantly influenced by personal health or activities performed to maintain health
Genetic Instruments
Health status measures
preference based measures (utility measures)
Specific Instruments
Disease specific
population specific
function specific
condition specific
QALY
a measure of value and benefit of health outcomes
incorporates both the quantity (mortality,death) and quality (morbidity:disease states)
Why measure Utility?
patient satisfaction is related to financial implications
-patient choice of health plans
-patient recommendation to other patients
-malpractice claims
Why measure Utility? part 2
-Patient satisfaction is related to clinical implications
-patients desire to adhere to providers directions, appointments and comply with treatments
characterisitics of utility measurement
subjective, individualized, personal, a room for biases
Biases for self assessment
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
QALY calculation
Utility X Years of life
Methods to determine utilities
rating scale, standard gamble, time tradeoff
rating scale
a line with scaled markings (thermometer)
Adavantages of CUA
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
Disadvantages of CUA
difficulty in measuring accurate QALY/utility
Utility measurement is not a precise or scientific measurement
-CUA less commonly used
CUA is a pharmaeconomic analysis that measures costs in dollars and quality adjusted life year
True
utility score is?
the point where 2 options are nearly equal and you cannot decide between the 2
Acquiescence
always agree with any item, regardless of the content of the question
Extremity
tendency to respond to the highest or lowest response alternative
Evasiveness
tendency to respond to the middle alternative
Carelessness
tendency to respond randomly or thoughtlessly
Social Desirability
tendency to respond in a conventional rather than truthful ways or when subjects want to be perceived as a good patient
Cost-Benefit Analysis
compares both costs and benefits (outcomes) in monetary units
-used to aid public policy (government uses for economic welfare)
What is CBA used for now?
irrigation and flood control, wildlife, air quality
A vaccination program for children
Advantages of CBA
many different outcomes-can compare multiple programs
can determine which program has the greatest benefit
disadvantages of CBA
can lead to biased or inaccurate estimates of the outcomes
Cost Components of CBA
Direct medical
Direct non-medical
Benefits of CBA
Direct medical
Direct non-medical
Indirect: HC (human capital), WTP (willing to pay)
Intangible: WTP
CBA: Direct medical cost Ex:
Cost to visit pharmacy for asthma program
-Spend $100 for asthma program
CBA: Direct medical benefit
Benefit of reduction in the number of ER visit
-Save $2,000 to visit ER
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)
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
HC has 2 types of wages?
A yearly wage rate (annual income)
A daily wage rate
A yearly wage rate used when?
Used for a program that would reduce long-term disability or death
-like a pneumococcal program
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
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
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
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 $$$
2 components of WTP
- Hypothetical Scenario
- Bidding Vehicles
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
Bidding Vehicles include:
-Open ended questions
-Closed ended questions
-bidding games
-payment card
Open ended questions
-Used the least because of wide range of values or what values to put in
closed ended questions
uses only one WTP value
take it or leave it (Yes or No)
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
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
2 ways to present CBA:
Net benefit or net cost=subtraction
benefit to cost ratio or cost to benefit ratio=division
net benefit=
total benefits - total costs
net cost=
total costs - total benefits
cost beneficial if?
net benefit >0 or net cost <0
benefits to cost ratio
total benefits/total costs
cost to benefit ratio
total costs/total benefits
Ratio-cost beneficial when?
Benefit to Cost >1 or Cost to benefit <1
Choose IRR (internal rate of return) if:
IRR > than the hurdle rate ->accept the project
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
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
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
3 methods to measure health states
- utility measures
- HRQoL Measures
- preference based classification
Utility measures
preference based or choice based
Uses the standard gamble and time tradeoff
time consuming and resource intensive
HRQoL Measures
non-utility or non-preference
surveys are multidimensional (multiple concepts) and do not result in once score
-complicates interpretation
2 ways to measure HRQoL
- General/Generic Measures
- Disease-specific measures
combo of both is recommended
General measures
generic measures:
SF-36
SF-12
scores compared for many diseases
may not be sensitive to differences for every disease
disease specific measures
condition specific measures
physical symptoms distress index
living with asthma questionnaire
-more narrow on patients views
cannot compare across pops.
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
4 dimensions of HRQoL?
- physical functioning
- psychological (mental) functioning
- Social/Role functioning
- General Health perception
3 instruments of HRQoL?
- reliability
- validity
- responsiveness
physical functioning?
observable limitations or disability
-energy level, bodily pain, activities of daily living
physcological (mental) functioning?
Psychological distress
-anxiety, depression, moodiness, life satisfaction, cognitive function
social functioning?
maintain social relationships
like social interactions
role functioning?
duties and responsibilities that are limited due to health
like working, school or household duties
general health perception
patients overall beliefs and evaluations
related to both patients perception on current health and future expectations
Reliabillity?
consistency o
same score on multiple administration?
like test-retest, internal consistency, interrater
reliability: test-retest
similarity of health status over time when no changes occur
reliability: internal consistency
assess correlation (agreement) between responses to questions within the same domains
like vitality: physically tired or worn out?
Reliability: Interrater
the correlation between 2 respondents of health status
like asking both mother and teacher
T or F: all valid tests are reliable
True
T or F: A reliable test may or may not be valid
True
validity
true representation
validity: content
face validity
if HRQoL offers adequate representation of the relevant variables
complete and relevant
Validity: Criterion
predictive validity
correlate with or predict health outcomes
High HRQoL scores predict?
less use of medical services
Low HRQoL scores predict?
higher rates of mortality
Validity Construct
Convergent, discriminant, known-group
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
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
Validity Construct-known-group
determines differences between patient groups known
ex: anxiety-first time mothers vs women already given birth
Responsiveness
captures information on change in health states
-Minimally important difference used (MID)
MID:
smallest change or difference in an outcome measure that is perceived as beneficial and would lead to change in patients medical management
preference based classification
a hybrid of the utility and HRQoL measures
-uses utility but based on math using predeveloped instruments
-less resource intensive
common domains measure in health care services
clinicians scientific knowledge
quality of clinician patient communication
provision of humane interpersonal treatment
degree of patients trust
Decision Analysis
compares different decision options
graphically displays choices
helps with selecting best or most cost effective option
Step 1: identify specific decisions
-good study design
objective of study, decision makers, perspectives, period of time
step 2: specify alternatives
new therapy vs standard
can compare more than 2 treatments
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
step 4 estimates:
specify costs, outcomes and probabilities
ICER formula
C1-C2 / E1 - E2
Markov Modeling
analyzes more complex outcomes and longer follow up periods
transition
patients may move between health states over periods of time
cycle (interval)
time period that is determined to be relevant to the specific disease or condition
absorbing state
when patients cannot move to another health state (dies)
Pharmaceutical services
functions done by a pharmacist that may or may not be associated with dispensing a particular prescription
pharmacy service programs
clinical, cognitive, pharmaceutical, disease state, MTM (ALL OF THE ABOVE)
PE study for pharmacy services
to determine whether the service is worthwhile financially
CBA is the most common to use
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
Budget Impact Analysis (BIA)
Technology!
to understand affordability of the new health care tech.
financial statements with or without new health care tech.
primary cost component is?
acquisition costs
costs of admin and monitoring and costs to treat AE
changes in disease related costs
can occur within time horizon (can offset new tech costs) or outside time horizon
costs of tech presented on?
annual basis
CUA is a subset of?
CEA
CUA measures
quantity (mortality: death) and quality (QUALY)
standard gamble: Alternative 1
YOU receive an intervention and can Die or be Healthy
standard gamble: Alternative 2
YOU receive no intervention
Choose Operation: point of indifference (use when not sure when to go with surgery) becomes the
UTILITY score
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)
Time trade off (choose to be healthy), calculate utility score?
point of indifference / time
