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Pharmacoeconomics > Exam 1 > Flashcards

Exam 1 Flashcards

0
Q

Medicaid

A

Low income

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1
Q

Medicare

A

Elderly

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2
Q

Chip

A

Children’s health insurance program

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3
Q

4 types of cost

A

Direct medical
Direct non medical
Indirect cost
Intangible

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4
Q

Ex direct medical costs

A 
Medication
Administration
Hospitalization
Diagnostic tests
Counseling
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5
Q

Ex direct non medical costs

A

Travel costs
Hotels
Child care
Meals on wheels

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6
Q

Examples indirect costs

A

Lost productivity patient care giver

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7
Q

How measure indirect costs

A

Human capital method

Willingness to pay

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8
Q

Human capital method

A

Based on individual earnings capacity

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9
Q

Willingness to pay

A

How much willing to pay to reduce likelihood of disease or avoid a negative outcome

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10
Q

Intangible costs

A

Pain and suffering
Stress
Fatigue
Anxiety

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11
Q

Incremental cost

A

Extra costs needed to purchase an additional unit of effect. Units get more costly as you march along

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12
Q

Opportunity costs

A

The value of the alternative that was forgone

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13
Q

Discounting

A

Value of money decreases over time

Need to use if looking at costs benefits over more than 1 year

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14
Q

Outcomes

A

Intermediate vs final

LDL levels vs death

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15
Q

Efficacy vs effectiveness

A

Efficacy like clinical trial with controlled environment etc

Effectiveness how works in the real world

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16
Q

Cost minimization

A

Need to prove outcomes are equivalent. If not cannot use.

Choose least costly alternative

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17
Q

Equivalency

A

Measure on qalys dollars

Also should consider safety factors

Assume inequivalent and need to prove

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18
Q

Cma. When use

A

Generic vs brand
Routes of admin
Admin settings
Antibiotic therapies

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19
Q

CBA

A

Values of resources consumed with value of outcomes benefits

Always valued in dollars

Can compare unrelated therapies but outcome must have common link

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20
Q

CBA benefit analysis

3 types

A

Net benefit
Net present value
Ratio analysis

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21
Q

Net benefit

A

Total benefits - total costs

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22
Q

Net present vale

A

Total benefitsdiscount rate - total costdiscount rate

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23
Q

CBA ratio analysis

A

Total benefits/total costs

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24
Q

Discount rate

A

Needed when analysis longer than 1 year

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25
Q

CBA Ratio vs net benefit

A

Ratio good for comparing 2 different programs

Net benefit used when need to know magnitude and exact $

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26
Q

Cost effectiveness analysis

A

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

27
Q

Cost effectiveness grid

A

Helps choose and categorize.

2 obvious outcomes.
2 outcomes that need more analysis

28
Q

CER and ICER

A

Cost effectiveness ratio

Incremental CER

29
Q

How evaluate effectiveness for CER

A

ID clinically relevant outcomes

Prefer final outcomes

30
Q

Units of CER

A

Cost per successful case

Cost per effective therapy

Per life year gained

31
Q

Units if ICER

A

Cost per additional life

32
Q

Definition of effectiveness important in CER analysis

A

Need to define desired outcome

Could be just success

Could be success plus success with side effects

33
Q

Cost Utility Analysis CUA

A

Sub type of CEA but uses utilities instead of $

Cannot use intermediate outcomes - need final outcomes

Often use QALYs for $

Patient perspective important

34
Q

Define utility

A

Numbers that represent strengths of individuals preferences for outcomes in the face of uncertainty

35
Q

Problem with CUA

A

Quality of life is subjective

36
Q

Sources for determining utility

A

Literature
Judgment (expert panel)
Psychometric theory (direct from subjects)

37
Q

Decision tree

A

Roadmap for making a decision

Organizes the decision process

38
Q 
Decision tree
Choice node
Chance node
Terminal node
Branch
Decision path
Rollback
Estimated average cost
A

Choice blue square
Chance green circle different probabilities
Terminal red triangle

39
Q

Steps for decision tree

A

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)

40
Q

If given probabilities what type of analysis?

A

Try decision tree

41
Q

4 types of analyses

A

Cma
CBA
CEA
Cua

42
Q

Types of perspectives

A 
Societal
Third-party payer
Institutional
Pharmacy dept
Individual
43
Q

Types of outcomes

A

Clinical - intermediate and final

Economic - direct, indirect, intangible

Humanistic - quality of life, satisfaction ( very subjective)

ECHO model

44
Q

How to measure health - types of health status instruments

A

General survey vs disease specific survey

45
Q

Determinants of health. Blum’s model

A

Environment
Lifestyle
Heredity
Medical care

In order of importance (ELHM)

46
Q

Quality of life vs health-related quality of life

A

QoL - subjective, particular to each individual

HRQoL - specific to effect of illness and treatment - as perceived by the patient

47
Q

Dimensions of health

A

Physical (capacity to perform physical)
Mental ( feeling states)
Social (participation and role function)
Spiritual (not commonly included)

48
Q

How measure health

A

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)

49
Q

How measure utility

A 
Standard gamble (probability p)
Time trade-off (h = x/t)
Rating scale (like thermometer)
50
Q

Essential properties of psychometrics

A

Reliable
Responsive
Valid

51
Q

Define scaling and 4 scale typed

A

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)

52
Q

Advantages of general health status instrument

A

Can apply across all health states
Can do broad comparisons (across different diseases)
May detect unanticipated effects

53
Q

Disadvantages of general health status instruments

A

May not be responsive to changes in health
May not be relevant for specific population
May be difficult to interpret

54
Q

Advantages of disease specific health instruments

A

More relevant for specific population

More responsive to changes in health status

55
Q

Disadvantages of disease specific health instruments

A

Cannot compare across populations

Cannot detect unanticipated effects

56
Q

Dimensions of SF-36

A 
Physical functioning
Role limitations due to physical conditions
Bodily pain
Social functioning
Mental health
Role limitations due to emotional problems
Vitality
General health perceptions
57
Q

Validity

A

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

58
Q

Construct validity - 3 types

A

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

59
Q

Responsiveness

A

Ability of health measure to detect changes in health status over time when changed do occur

Floor ceiling effect. Level of measurement (likely)

60
Q

Reliability

A

Ability to obtain same results under different circumstances for an individual (consistency)

Need to be reliable to be valid

61
Q

Types of reliability

A

Internal consistency - correlation across items that address same domain

Test-retest

Inter-rater reliability

62
Q

How administer surveys?

A 
Self-administration
Mail administration
Interview
Telephone
Computer-assisted
Proxy reporting
Mixed modes
63
Q

Markov model compared to decision tree analysis

A

More complex
Accommodates many cycles and intervals
Transition between health states - can cycle back
Continually transition until absorbing state

64
Q

Steps in Markov modeling

A 
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

Pharmacoeconomics (1 decks)

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