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MRCPsych Part B > Economic Studies > Flashcards

Economic Studies Flashcards

1
Q

What can economic analysis do?

A

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

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2
Q

What types of economic studies are there?

A

Cost minimisation
Cost effectiveness
Cost utility
Cost benefit
Cost consequences

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3
Q

Output of cost effectiveness

A

Clinical measurement scales

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4
Q

Output of cost utility

A

Life utility units (DALY, QoL)

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5
Q

Output of cost benefit

A

Money

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6
Q

Output of cost consequences

A

Any natural units (days saved, deaths prevented etc)

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7
Q

Usage of cost minimisation

A

When both interventions produce same outcome
Only costs compared

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8
Q

Usage of cost effectiveness

A

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

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9
Q

Usage of cost utility

A

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

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10
Q

Usage of cost benefit

A

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

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11
Q

Who often uses cost benefit studies?

A

Managers to decide how to allocate money effectively

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12
Q

Usage of cost consequences

A

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

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13
Q

Another name for cost consequences studies?

A

Disaggregated approach

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14
Q

How can costs be calculated?

A

Direct
Indirect
Intangible
Opportunity

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15
Q

Examples of direct costs

A

Hospital space
Drugs
Equipment
Salary of healthcare staff

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16
Q

Examples of indirect costs

A

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

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17
Q

Examples of intangible costs

A

Cost of pain and suffering
Social stigma

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18
Q

What is opportunity costs?

A

Cost of wasted opportunities

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19
Q

How can benefits be calculated?

A

Economic
Clinical
QoL

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20
Q

What are economic benefits?

A

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

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21
Q

What are clinical benefits?

A

Improvement in rating scales
Life years gained
Deaths prevent

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22
Q

What is a health state preference value?

A

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

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23
Q

How to calculate health state preference value?

A

Rating scales
Time trade-off
Standard gamble
Willingness to pay

24
Q

How do rating scales work for health state preference value?

A

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

25
Q

What are time trade off measures?

A

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

26
Q

What is the standard gamble measure?

A

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

27
Q

What is willingness to pay?

A

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

28
Q

What aspects of economic studies can be critically appraised?

A

Viewpoints
Clinical effectiveness
Incremental values
Sensitivity analysis

29
Q

Why are viewpoints important to appraise in economic studies?

A

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

30
Q

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

A

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

31
Q

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

A

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

32
Q

When must incremental calculations be done?

A

If two interventions are compared in an economic analysis

33
Q

How can sensitive analysis be done?

A

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

34
Q

What is one way analysis?

A

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

35
Q

Disadvantage of one way analysis?

A

Could underestimate uncertainty as only one variable is changed

36
Q

What is extreme scenario analysis?

A

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

37
Q

What is two way analysis?

A

Two variables changed simultaneously to observe effects.

38
Q

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

A

Monte-Carlo simulation

39
Q

What is Monte-carlo simulation?

A

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

40
Q

What is Bootstrapping technique?

A

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

41
Q

Most popular economic evaluation method in healthcare?

A

Cost effectiveness analysis

42
Q

How can cost effectiveness analysis be summarised?

A

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

43
Q

What is ACER equal to?

A

Cost/effect

44
Q

What is ICER a measure of?

A

Additional cost per unit of health gained

45
Q

Formula of ICER

A

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

46
Q

How can incremental cost and effect be represented visually?

A

Incremental cost-effectiveness plane

47
Q

X and Y axis of incremental cost-effectiveness plane?

A

X: incremental cost
Y: incremental effect

48
Q

Explain results of plot of incremental cost-effectiveness plane

A

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

49
Q

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

A

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

50
Q

What is the maximum acceptable ceiling ratio?

A

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

51
Q

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

A

If ICER falls below maximum acceptable ceiling ratio

52
Q

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

A

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

53
Q

How can one summarise the results of multiple economic evaluations?

A

Narrative, descriptive summary
Permutation matrix

54
Q

Who suggested the idea of a permutation matrix?

A

Nixon

55
Q

What happens in a permutation matrix?

A

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

56
Q

What does permutation matrix allow?

A

Pool multiple analyses and choose most cont-effective intervention overall

MRCPsych Part B (64 decks)

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