Exam Flashcards
What is the decision-tool to compare costs with consequences?
ECHO
What does ECHO stand for?
Economic (money)
Clinical (BP measures)
Humanistic consequences (outcomes/QOL)
“Can it work?” is an example of what?
Efficacy (phase II trials)
“Does it work?” is an example of what?
Effectiveness
“Is it reaching those who need it?” is an example of what?
Availability
What is properly allocating resources, lowest cost/unit of output?
Efficiency
What is pharmacoeconomics?
Economic evaluation of pharmacotherapy
Tool to identify, measure, and compare costs and outcomes of use of pharmaceutical products and services
What is the equation for value?
Value = Benefits/costs
What do healthcare providers mean by added value?
Cost-effectiveness
What do healthcare providers mean by what is it going to cost?
Budget impact
What is PEC?
Pharmacoeconomics
What are the essential elements of economic analyses?
Cost determinants
Measuring costs
Discounting costs
Sensitivity analysis
What are the three pieces that determine cost of therapy?
Identification
Measurement
Valuation
What is identification in determining cost of therapy?
All relevant resources consumed by intervention need to be identified
What is measurement in determining cost of therapy?
Magnitude of resource consumption, in numbers
What is valuation in determine cost of therapy?
Placing monetary value on quantified resource consumptions
What are tangible costs and benefits?
Direct medical costs/benefits
Direct non-medical costs/benefits
Indirect costs/benefits
What are intangible costs and benefits?
Unquantifiable costs and benefits
- Improved health after treatment
- Reduced pain
- Pain and suffering associated with tx
What are direct medical costs?
Medications Medication monitoring Medication administration Pt counseling/consultations Diagnostic tests Hospitalizations Clinic visits ED visits Home medical visits Ambulance services Nursing services
What are direct nonmedical costs?
Travel costs to receive health care
Nonmedical assistance related to condition (Meals-on-wheels, homemaking service)
Hotel stays for patient/family for out-of-town care
Child care services for children of patients
What are indirect costs?
Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity b/c of premature mortality
What are intangible costs?
Pain and suffering
Fatigue
Anxiety
What is the Drummond classification of costs?
Health care sector costs
Other sector costs
Patient and family costs
Productivity costs
What are sources of cost?
Payers Third part vendors Providers Biomedical, biopharmaceutical and pharmaceutical companies Patient and caregiver reported Tertiary data sources
Who are payers?
Managed care providers
Pharmacy benefit managers
Medicare
Medicaid
Who are third party vendors?
Purchase proprietary data from variety of sources and aggregate
Group purchasing organizations
Management companies
Who are providers?
Health systems
Individual providers
Pharmacies, hospitals, etc
Who are tertiary data sources?
Micromedex contains Red Book Prices (AWP)
What are types of hospital costing?
Micro-costing
Case-mix group
Disease specific per diem (daily cost)
Per diem
What is micro-costing?
Each component of resource used quantified, measured, valued
What is case-mix group?
Gives cost for each category of case/type of patient
Accounts for LOS
What is disease specific per diem?
Gives mean daily cost for treatment of certain diseases
What is per diem hospital costing?
Mean daily cost for all patients
Which type of costing is the most precise?
Micro-costing
An ambulance cost is what type of cost?
Direct medical cost
Improved health after treatment would be what type of cost?
Intangible
What is the main goal of tracking costs and outcomes?
Not to mislead policy maker
When do we use short-term tracking?
In hospital - to discharge
When do we use medium term tracking?
Payer - 1-5 years
When do we use long term tracking?
Patients - lifetime
What are the two types of differential timing costs?
Cost standardization-past costs to present
Discounting-future costs to present
What is a short term discounting cost?
< 1 yr, really no need
What is a longer-term tracking discounting cost?
1+ year
Why do we discount/standardize?
Inflation - $ today worth more dollar in future
People would rather have certain benefit today than one in future
What is the ISPOR equation for discounting?
PV = FC x DF (n,r) PV = present value FC = future costs DF = discount factor n = number of years r = discount rate
What are the types of PEC analysis?
Cost-minimization
Cost-effectiveness
Cost-benefit
Cost-utility
What are the costs and outcomes of cost-minimization?
Costs = monetary units Outcomes = assumed to be equivalent
What are the costs and outcomes of cost-effectiveness
Costs = monetary units Outcomes = naturals units (life years saved)
What are the costs and outcomes of cost-benefit?
Costs = monetary units Outcomes = monetary units
What are the costs and outcomes of cost-utility?
Costs = monetary units Outcomes = Quality-adjusted life years
What is the most common type of PEC analysis?
Cost-effectiveness
When is a cost-effectiveness analysis used?
Limited budget and have range of options w/in a field
How must the outcomes compare in a cost-effectiveness analysis?
Outcome is same unit
What does a cost-effectiveness analysis compare?
Costs and consequences of two alternative treatments
What is the calculation for cost-effectiveness?
ICER (incremental cost-effectiveness ratio)
(Cost1 - Cost2) / (Outcome1 - Outcome 2)
1 = new drug
2 = comparator
When are interventions said to be cost-effective?
Less expensive AND more effective
Less expensive AND at least as effective
More expensive AND more effective
What intervention is said to not be cost effective?
Higher cost and less effective
When is an ICER positive?
New tx more expensive AND more effective
New tx less costly and less effective
Generally want smaller ICER
When is an ICER negative?
New tx less costly and more effective
New tx more costly AND less effective
When are cost-effectiveness analysis most applicable?
Comparing costs/outcomes of 2+ alternative HTN med
Compare 2+ alternative programs to prevent mortality
What is a surrogate outcome?
Intermediate
Easy to measure/obtain
Needs to be related to hard outcome
In a CEA, what should be included in the methods?
Explicit description of costs/consequences
Perspective analysis
Methods and sources of data
What are limitations to ICER?
Relatively small positive ICER driven by small increase in cost OR large gain in effectiveness
Conveys limited information to policy-makers
What do negative ICER scenarios represent?
New medication/service dominant
OR
New medication/service being dominated
What are the parts of QALY?
Life gained (mortality)
AND
Quality of that life gained (morbidity)
When should a cost-utility analysis be used?
When HRQOL is most/an important outcome
When program/service affects mortality and morbidity and you want common unit to measure both
When program/service have wide range of different kinds of outcomes and you want common unit of output for comparison
Limited budget, policy-maker must determine which program/service to reduce/eliminate to free-up funding for new program/service
Allocate limited resources optimally and using constrained optimization to maximize health gain achieved
What are problems with CUA?
Most difficult/ time-consuming/ expensive economic evaluation
How is QALY usually measured?
Years
What is the scale for QALY?
Anchored on scale from 0 (death) to 1 (perfect health)
Can be adjusted to reflect states worse than death (< 0)
What is the focus of QALY?
Health states
How is QALY calculated?
If utilities are same, then difference in QALYs is difference in AUC
If utilities are different, then adjust to estimate incremental QALYs
Life gained x utility
How do we obtain utility weights?
Utility is preference
Through literature
Direct measurement from patients/general public
What are the 3 methods for measuring utility?
Standard gamble (SG)
Time trade-off (TTO)
Visual analog scale (VAS)
A CUA is a type of what other analysis?
CEA
What is the SG based on?
Utility theory
How many alternatives are available in a standard gamble?
2
What is alternative 1 in a standard gamble?
Tx w/2 outcomes:
- Returned to perfect health and lives for additional x years
- Patient dies immediately
What is alternative 2 in a SG?
Certain outcome of chronic state i for life
How is SG probability manipulated?
Until subject indifferent b/t two alternatives which is preference score
