Evidence Based Practice, Resource Allocation and Health Economics Flashcards
What do the following words mean in the context of health economics?
Utility
Opportunity Cost
Utility
value an individual places on a health state
Opportunity Cost
once a resource is used, it is unavailable for other purposes
What do the following words mean in the context of health economics?
Equity
Effectiveness
Equity
extent that resource distribution is fair
Effectiveness
extent to which an intervention produces the desired outcome
What do the following words mean in the context of health economics?
Scarcity
Efficiency
Scarcity
needs outstripped resources
Efficiency
maximising output from limited resources
Why are quality adjusted life years used ratehr than life-years gained to asses effectiveness?
not all interventions have survivial as the main outcome - it may be more important to improve a persons quality of life rather than to prolong it
What is a quality adjusted life year (QALY)?
composite of survival and quality of life
1 Year of PERFECT HEALTH = 1 QALY
(adjust life expectancy for quality of life)
Use QALYs to help calculate this cost utility analysis to identify which is more cost effective
Female diagnosed with peptic ulcer @ age 54, expected to live 23 years with QoL of 0.7 with no treatment
With Treatment A:
- expected to have 0.95 of perfect health, at a cost of £50 per year
With Treatment B:
- expected to have 0.8 of perfect health, at a cost of £30 per year
QALY with no Treatment
- 0.7 x 23 years = 16.1 QALYs
QALY with Treatment A
- 0.95 x 23 = 21.85 QALYs
- Gain of 5.75 QALYs (21.85 - 16.1)
- Total cost = 23 years x £50 = £1150 per year
- £1150 / 5.75 = £200 per QALY gained
QALY with Treatment B
- 0.80 x 23 = 18.4 QALYs
- Gain of 2.3 QALYs (18.4 - 16.1)
- Total cost = 23 years x £30 = £690 per year
- £630 / 2.3 = £300 per QALY gained
Treatment A is more expensive, but it is more cost effective when you compare benefits and cost
A man is diagnosed with cancer and is told the following:
without treatment he will live for 1 year with 0.8 of perfect health
with treatment he will live for 4 years with 0.2 of perfect health
calculate the QALY for each option and state which is best for his quality of life?
Without Treatment
1 x 0.8 = 0.8 QALYs
With Treatment
4 x 0.2 = 0.8 QALYs
no gain in QALYs associated with treatment
State 3 disadvantages of QALYs
do not distribute resources according to need, rather accoring to benefit gained per unit cost
may not embrance all dimensions of benefit
do not assess imact on carers or families
Why is evidence based medicine required?
- Reduce harm caused by interventions
- Prevent wastage of resources that can be used more effectively
- Ensure equity of treatment across different locations
What is evidence-based practice?
Integration of individual expertise with the best available external evidence from systematic research
What are 2 advantages of systematic reviews?
- Save clinicians time from needing to locate and appraise individual studies
- Offer generalisable and up to date conclusions
- Increase certainty and quality of recommendations
What are 2 problems associated with evidence based practice?
impossible to create and maintain systematic reviews across all specialities
challenging and expensive to disseminate
outcomes are often biomedial
can create ‘unreflective rule followers’ rather than professionals
What are the 4 methods that can be used to compare costs and benefits in healthcare?
- Cost minimisation analysis
- Cost effectiveness analysis
- Cost benefit analysis
- Cost utility analysis
all methods consider the cost, but differ in the extent they measure and value consequences/benefits
What is cost minimisation analysis?
outcomes are assumed to be equivalet
focus on the costs
e.g. prosthetic hip replacement improve mobility equally - which is the cheapest (minimise the cost)?
What is cost effectiveness analysis?
compared in terms of cost per unit outcome
e.g. cost per reduction of 5mmHg when using 2 different blood pressure medicines
