Exam 1 Flashcards
Medicaid
Low income
Medicare
Elderly
Chip
Children’s health insurance program
4 types of cost
Direct medical
Direct non medical
Indirect cost
Intangible
Ex direct medical costs
Medication Administration Hospitalization Diagnostic tests Counseling
Ex direct non medical costs
Travel costs
Hotels
Child care
Meals on wheels
Examples indirect costs
Lost productivity patient care giver
How measure indirect costs
Human capital method
Willingness to pay
Human capital method
Based on individual earnings capacity
Willingness to pay
How much willing to pay to reduce likelihood of disease or avoid a negative outcome
Intangible costs
Pain and suffering
Stress
Fatigue
Anxiety
Incremental cost
Extra costs needed to purchase an additional unit of effect. Units get more costly as you march along
Opportunity costs
The value of the alternative that was forgone
Discounting
Value of money decreases over time
Need to use if looking at costs benefits over more than 1 year
Outcomes
Intermediate vs final
LDL levels vs death
Efficacy vs effectiveness
Efficacy like clinical trial with controlled environment etc
Effectiveness how works in the real world
Cost minimization
Need to prove outcomes are equivalent. If not cannot use.
Choose least costly alternative
Equivalency
Measure on qalys dollars
Also should consider safety factors
Assume inequivalent and need to prove
Cma. When use
Generic vs brand
Routes of admin
Admin settings
Antibiotic therapies
CBA
Values of resources consumed with value of outcomes benefits
Always valued in dollars
Can compare unrelated therapies but outcome must have common link
CBA benefit analysis
3 types
Net benefit
Net present value
Ratio analysis
Net benefit
Total benefits - total costs
Net present vale
Total benefitsdiscount rate - total costdiscount rate
CBA ratio analysis
Total benefits/total costs
Discount rate
Needed when analysis longer than 1 year
CBA Ratio vs net benefit
Ratio good for comparing 2 different programs
Net benefit used when need to know magnitude and exact $
Cost effectiveness analysis
Used for alternative treatments that have common measure of effect
Outcomes must be measured in same clinical units
Choose option with least cost per measured outcome
Must be within a disease state
Cost effectiveness grid
Helps choose and categorize.
2 obvious outcomes.
2 outcomes that need more analysis
CER and ICER
Cost effectiveness ratio
Incremental CER
How evaluate effectiveness for CER
ID clinically relevant outcomes
Prefer final outcomes
Units of CER
Cost per successful case
Cost per effective therapy
Per life year gained
Units if ICER
Cost per additional life
Definition of effectiveness important in CER analysis
Need to define desired outcome
Could be just success
Could be success plus success with side effects
Cost Utility Analysis CUA
Sub type of CEA but uses utilities instead of $
Cannot use intermediate outcomes - need final outcomes
Often use QALYs for $
Patient perspective important
Define utility
Numbers that represent strengths of individuals preferences for outcomes in the face of uncertainty
Problem with CUA
Quality of life is subjective
Sources for determining utility
Literature
Judgment (expert panel)
Psychometric theory (direct from subjects)
Decision tree
Roadmap for making a decision
Organizes the decision process
Decision tree Choice node Chance node Terminal node Branch Decision path Rollback Estimated average cost
Choice blue square
Chance green circle different probabilities
Terminal red triangle
Steps for decision tree
ID decision ( timeframe and perspective)
Draw tree
Assess probability
Determine value of each outcome ($ CER or QALY)
Calculate cost per treatment (rollback)
Determine robustness (sensitivity analysis)
If given probabilities what type of analysis?
Try decision tree
4 types of analyses
Cma
CBA
CEA
Cua
Types of perspectives
Societal Third-party payer Institutional Pharmacy dept Individual
Types of outcomes
Clinical - intermediate and final
Economic - direct, indirect, intangible
Humanistic - quality of life, satisfaction ( very subjective)
ECHO model
How to measure health - types of health status instruments
General survey vs disease specific survey
Determinants of health. Blum’s model
Environment
Lifestyle
Heredity
Medical care
In order of importance (ELHM)
Quality of life vs health-related quality of life
QoL - subjective, particular to each individual
HRQoL - specific to effect of illness and treatment - as perceived by the patient
Dimensions of health
Physical (capacity to perform physical)
Mental ( feeling states)
Social (participation and role function)
Spiritual (not commonly included)
How measure health
Utility - value of a particular health state, measured by assigning preferences to health states
Psychometric - how judge physical attributes for which there are no physical scales ( attitudes beliefs behavior knowledge)
How measure utility
Standard gamble (probability p) Time trade-off (h = x/t) Rating scale (like thermometer)
Essential properties of psychometrics
Reliable
Responsive
Valid
Define scaling and 4 scale typed
Scaling - assigning # to item responses
NOIR
Nominal - qualitative (name, zip code, m or f)
Ordinal - rank order (better or worse)
Interval - number of how much better or worse (zero is arbitrary)
Ratio - how much better or worse by magnitude (zero is meaningful)
Advantages of general health status instrument
Can apply across all health states
Can do broad comparisons (across different diseases)
May detect unanticipated effects
Disadvantages of general health status instruments
May not be responsive to changes in health
May not be relevant for specific population
May be difficult to interpret
Advantages of disease specific health instruments
More relevant for specific population
More responsive to changes in health status
Disadvantages of disease specific health instruments
Cannot compare across populations
Cannot detect unanticipated effects
Dimensions of SF-36
Physical functioning Role limitations due to physical conditions Bodily pain Social functioning Mental health Role limitations due to emotional problems Vitality General health perceptions
Validity
Measures what it is supposed to measure and not what not to measure
Face validity - makes sense
Criterion validity - compares measure to external criteria like clinical assessment
Construct validity - results align across domains
Content validity - comprehensive
Construct validity - 3 types
Convergent - when scales used to measure mental health are highly related (correlated) to the mental factor
Discriminant - scales to measure one aspect like physical health differ in their relationship to the physical health factor and the mental health factor
Known groups
Responsiveness
Ability of health measure to detect changes in health status over time when changed do occur
Floor ceiling effect. Level of measurement (likely)
Reliability
Ability to obtain same results under different circumstances for an individual (consistency)
Need to be reliable to be valid
Types of reliability
Internal consistency - correlation across items that address same domain
Test-retest
Inter-rater reliability
How administer surveys?
Self-administration Mail administration Interview Telephone Computer-assisted Proxy reporting Mixed modes
Markov model compared to decision tree analysis
More complex
Accommodates many cycles and intervals
Transition between health states - can cycle back
Continually transition until absorbing state
Steps in Markov modeling
Choose health states Determine possible transitions Choose cycle length and how many cycles Estimate probabilities of transitions Estimate costs and outcomes associated with each option
