Economic Studies Flashcards
What can economic analysis do?
Inform decision makers about cost effectiveness and benefits of an intervention.
What types of economic studies are there?
Cost minimisation Cost effectiveness Cost utility Cost benefit Cost consequences
Output of cost effectiveness
Clinical measurement scales
Output of cost utility
Life utility units (DALY, QoL)
Output of cost benefit
Money
Output of cost consequences
Any natural units (days saved, deaths prevented etc)
Usage of cost minimisation
When both interventions produce same outcome
Only costs compared
Usage of cost effectiveness
When both interventions result in a outcome that can be measured using same clinical scale
Usage of cost utility
When apart from clinical effect one also has to consider holistic disease burden, side effects etc
Usage of cost benefit
When two interventions with different clinical outcomes are compared - outcomes translated into money
Who often uses cost benefit studies?
Managers to decide how to allocate money effectively
Usage of cost consequences
Two different interventions with different outcomes compared - use natural units instead of money
Another name for cost consequences studies?
Disaggregated approach
How can costs be calculated?
Direct
Indirect
Intangible
Opportunity
Examples of direct costs
Hospital space
Drugs
Equipment
Salary of healthcare staff
Examples of indirect costs
Costs from loss of productivity for patient
Cost of having caretaker for ones child when in hospital etc
Examples of intangible costs
Cost of pain and suffering
Social stigma
What is opportunity costs?
Cost of wasted opportunities
How can benefits be calculated?
Economic
Clinical
QoL
What are economic benefits?
Amount saved due to prevention and treatment of illness
Avoidance of admission
Return to work
What are clinical benefits?
Improvement in rating scales
Life years gained
Deaths prevent
What is a health state preference value?
The value that a person will place in a health state in a hypothetical situation.
How to calculate health state preference value?
Rating scales
Time trade-off
Standard gamble
Willingness to pay
How do rating scales work for health state preference value?
Respondent asked to indicate on a line where they would place a particular health state.
0 = death
What are time trade off measures?
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
What is the standard gamble measure?
Imagine there is a risky intervention for a health state; how much risk would a respondent accept to get cured with this intervention?
What is willingness to pay?
How much would people be prepared to pay to prevent or cure a particular health state?
What aspects of economic studies can be critically appraised?
Viewpoints
Clinical effectiveness
Incremental values
Sensitivity analysis
Why are viewpoints important to appraise in economic studies?
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
Why is it important to appraise clinical effectiveness in economic studies?
Compared intervention may be cheap but what if they dont work?
It is unnecessary to compare two ineffective interventions to assess relative economic benefits
Why is it important to appraise incremental values in economic studies?
Can lead to wrong conclusions leading to interventions appearing to be cost effective.
When must incremental calculations be done?
If two interventions are compared in an economic analysis
How can sensitive analysis be done?
One way Two way Extreme scenario Monto-carlo simulation Bootstrapping technique
What is one way analysis?
Change one variable in a plausible manner at a particular economic circumstance and observe its effect on outcome.
Disadvantage of one way analysis?
Could underestimate uncertainty as only one variable is changed
What is extreme scenario analysis?
Set one variable to either maximal or minimal and examine changes in outcome.
Will overestime uncertainty
What is two way analysis?
Two variables changed simultaneously to observe effects.
What is recommended if two way analysis is to be done?
Monte-Carlo simulation
What is Monte-carlo simulation?
Uncertainty in each utility is assumed to possess a probability distribution while estimating the predicted effects
What is Bootstrapping technique?
Effect of resampling the data set is investigated. Any variability in outcome depends on precision of originally reported results
Most popular economic evaluation method in healthcare?
Cost effectiveness analysis
How can cost effectiveness analysis be summarised?
Average cost-effectiveness ratio (ACER)
Incremental cost-effectiveness ratio (ICER)
What is ACER equal to?
Cost/effect
What is ICER a measure of?
Additional cost per unit of health gained
Formula of ICER
(cost of proposed intervention - cost of control intervention) / (effect of proposed intervention - effect of control intervention)
How can incremental cost and effect be represented visually?
Incremental cost-effectiveness plane
X and Y axis of incremental cost-effectiveness plane?
X: incremental cost
Y: incremental effect
Explain results of plot of incremental cost-effectiveness plane
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
How does one use the ICER to decide if an intervention offers value for money?
ICER must be compared to maximum amount that decision-maker is willing to pay for health effects
What is the maximum acceptable ceiling ratio?
Maximum amount that decision-maker is willing to pay for health effects
When is an intervention deemed to be cost effective when using the ICER?
If ICER falls below maximum acceptable ceiling ratio
How can probability of cost effectiveness of an intervention be tested?
Using Cost-effectiveness acceptability curve on the incremental cost-effectiveness plane
How can one summarise the results of multiple economic evaluations?
Narrative, descriptive summary
Permutation matrix
Who suggested the idea of a permutation matrix?
Nixon
What happens in a permutation matrix?
Incremental effectiveness is categorised into positive, negative or neutral. Incremental costs are categorised to higher, same and lower.
What does permutation matrix allow?
Pool multiple analyses and choose most cont-effective intervention overall