Economic Studies

Question 1

What can economic analysis do?

Answer 1

Inform decision makers about cost effectiveness and benefits of an intervention.

Question 2

What types of economic studies are there?

Answer 2

Cost minimisation
Cost effectiveness
Cost utility
Cost benefit
Cost consequences

Question 3

Output of cost effectiveness

Answer 3

Clinical measurement scales

Question 4

Output of cost utility

Answer 4

Life utility units (DALY, QoL)

Question 5

Output of cost benefit

Answer 5

Money

Question 6

Output of cost consequences

Answer 6

Any natural units (days saved, deaths prevented etc)

Question 7

Usage of cost minimisation

Answer 7

When both interventions produce same outcome
Only costs compared

Question 8

Usage of cost effectiveness

Answer 8

When both interventions result in a outcome that can be measured using same clinical scale

Question 9

Usage of cost utility

Answer 9

When apart from clinical effect one also has to consider holistic disease burden, side effects etc

Question 10

Usage of cost benefit

Answer 10

When two interventions with different clinical outcomes are compared - outcomes translated into money

Question 11

Who often uses cost benefit studies?

Answer 11

Managers to decide how to allocate money effectively

Question 12

Usage of cost consequences

Answer 12

Two different interventions with different outcomes compared - use natural units instead of money

Question 13

Another name for cost consequences studies?

Answer 13

Disaggregated approach

Question 14

How can costs be calculated?

Answer 14

Direct
Indirect
Intangible
Opportunity

Question 15

Examples of direct costs

Answer 15

Hospital space
Drugs
Equipment
Salary of healthcare staff

Question 16

Examples of indirect costs

Answer 16

Costs from loss of productivity for patient
Cost of having caretaker for ones child when in hospital etc

Question 17

Examples of intangible costs

Answer 17

Cost of pain and suffering
Social stigma

Question 18

What is opportunity costs?

Answer 18

Cost of wasted opportunities

Question 19

How can benefits be calculated?

Answer 19

Economic
Clinical
QoL

Question 20

What are economic benefits?

Answer 20

Amount saved due to prevention and treatment of illness
Avoidance of admission
Return to work

Question 21

What are clinical benefits?

Answer 21

Improvement in rating scales
Life years gained
Deaths prevent

Question 22

What is a health state preference value?

Answer 22

The value that a person will place in a health state in a hypothetical situation.

Question 23

How to calculate health state preference value?

Answer 23

Rating scales
Time trade-off
Standard gamble
Willingness to pay

Question 24

How do rating scales work for health state preference value?

Answer 24

Respondent asked to indicate on a line where they would place a particular health state.
0 = death

Question 25

What are time trade off measures?

Answer 25

How many of the remaining life years would a respondent be willing to spend in trying to get cured of a specific condition i.e. how important is it for someone to get complete relief from a disease

Question 26

What is the standard gamble measure?

Answer 26

Imagine there is a risky intervention for a health state; how much risk would a respondent accept to get cured with this intervention?

Question 27

What is willingness to pay?

Answer 27

How much would people be prepared to pay to prevent or cure a particular health state?

Question 28

What aspects of economic studies can be critically appraised?

Answer 28

Viewpoints Clinical effectiveness Incremental values Sensitivity analysis

Question 29

Why are viewpoints important to appraise in economic studies?

Answer 29

Conclusions of economic analysis may vary based on who is estimating cost v benefits. Conclusions must be interpreted in context of the viewpoints employed in the analysis

Question 30

Why is it important to appraise clinical effectiveness in economic studies?

Answer 30

Compared intervention may be cheap but what if they dont work? It is unnecessary to compare two ineffective interventions to assess relative economic benefits

Question 31

Why is it important to appraise incremental values in economic studies?

Answer 31

Can lead to wrong conclusions leading to interventions appearing to be cost effective.

Question 32

When must incremental calculations be done?

Answer 32

If two interventions are compared in an economic analysis

Question 33

How can sensitive analysis be done?

Answer 33

One way Two way Extreme scenario Monto-carlo simulation Bootstrapping technique

Question 34

What is one way analysis?

Answer 34

Change one variable in a plausible manner at a particular economic circumstance and observe its effect on outcome.

Question 35

Disadvantage of one way analysis?

Answer 35

Could underestimate uncertainty as only one variable is changed

Question 36

What is extreme scenario analysis?

Answer 36

Set one variable to either maximal or minimal and examine changes in outcome. Will overestime uncertainty

Question 37

What is two way analysis?

Answer 37

Two variables changed simultaneously to observe effects.

Question 38

What is recommended if two way analysis is to be done?

Answer 38

Monte-Carlo simulation

Question 39

What is Monte-carlo simulation?

Answer 39

Uncertainty in each utility is assumed to possess a probability distribution while estimating the predicted effects

Question 40

What is Bootstrapping technique?

Answer 40

Effect of resampling the data set is investigated. Any variability in outcome depends on precision of originally reported results

Question 41

Most popular economic evaluation method in healthcare?

Answer 41

Cost effectiveness analysis

Question 42

How can cost effectiveness analysis be summarised?

Answer 42

Average cost-effectiveness ratio (ACER) Incremental cost-effectiveness ratio (ICER)

Question 43

What is ACER equal to?

Answer 43

Cost/effect

Question 44

What is ICER a measure of?

Answer 44

Additional cost per unit of health gained

Question 45

Formula of ICER

Answer 45

(cost of proposed intervention - cost of control intervention) / (effect of proposed intervention - effect of control intervention)

Question 46

How can incremental cost and effect be represented visually?

Answer 46

Incremental cost-effectiveness plane

Question 47

X and Y axis of incremental cost-effectiveness plane?

Answer 47

X: incremental cost Y: incremental effect

Question 48

Explain results of plot of incremental cost-effectiveness plane

Answer 48

ICER falls north west: positive cost and negative effects - no use of intervention ICER falls south east: negative costs and positive effects - intervention preferred ICER falls northeast: positive effects and positive costs - needs further consideration ICER falls southwest: negative costs and negative effects - not clinically effective

Question 49

How does one use the ICER to decide if an intervention offers value for money?

Answer 49

ICER must be compared to maximum amount that decision-maker is willing to pay for health effects

Question 50

What is the maximum acceptable ceiling ratio?

Answer 50

Maximum amount that decision-maker is willing to pay for health effects

Question 51

When is an intervention deemed to be cost effective when using the ICER?

Answer 51

If ICER falls below maximum acceptable ceiling ratio

Question 52

How can probability of cost effectiveness of an intervention be tested?

Answer 52

Using Cost-effectiveness acceptability curve on the incremental cost-effectiveness plane

Question 53

How can one summarise the results of multiple economic evaluations?

Answer 53

Narrative, descriptive summary Permutation matrix

Question 54

Who suggested the idea of a permutation matrix?

Answer 54

Nixon

Question 55

What happens in a permutation matrix?

Answer 55

Incremental effectiveness is categorised into positive, negative or neutral. Incremental costs are categorised to higher, same and lower.

Question 56

What does permutation matrix allow?

Answer 56

Pool multiple analyses and choose most cont-effective intervention overall