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Pharmacoeconomics > Exam > Flashcards

Exam Flashcards

1
Q

What is the decision-tool to compare costs with consequences?

A

ECHO

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2
Q

What does ECHO stand for?

A

Economic (money)
Clinical (BP measures)
Humanistic consequences (outcomes/QOL)

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3
Q

“Can it work?” is an example of what?

A

Efficacy (phase II trials)

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4
Q

“Does it work?” is an example of what?

A

Effectiveness

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5
Q

“Is it reaching those who need it?” is an example of what?

A

Availability

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6
Q

What is properly allocating resources, lowest cost/unit of output?

A

Efficiency

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7
Q

What is pharmacoeconomics?

A

Economic evaluation of pharmacotherapy

Tool to identify, measure, and compare costs and outcomes of use of pharmaceutical products and services

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8
Q

What is the equation for value?

A

Value = Benefits/costs

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9
Q

What do healthcare providers mean by added value?

A

Cost-effectiveness

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10
Q

What do healthcare providers mean by what is it going to cost?

A

Budget impact

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11
Q

What is PEC?

A

Pharmacoeconomics

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12
Q

What are the essential elements of economic analyses?

A

Cost determinants
Measuring costs
Discounting costs
Sensitivity analysis

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13
Q

What are the three pieces that determine cost of therapy?

A

Identification
Measurement
Valuation

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14
Q

What is identification in determining cost of therapy?

A

All relevant resources consumed by intervention need to be identified

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15
Q

What is measurement in determining cost of therapy?

A

Magnitude of resource consumption, in numbers

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16
Q

What is valuation in determine cost of therapy?

A

Placing monetary value on quantified resource consumptions

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17
Q

What are tangible costs and benefits?

A

Direct medical costs/benefits
Direct non-medical costs/benefits
Indirect costs/benefits

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18
Q

What are intangible costs and benefits?

A

Unquantifiable costs and benefits

  • Improved health after treatment
  • Reduced pain
  • Pain and suffering associated with tx
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19
Q

What are direct medical costs?

A 
Medications
Medication monitoring
Medication administration
Pt counseling/consultations
Diagnostic tests
Hospitalizations
Clinic visits
ED visits
Home medical visits
Ambulance services
Nursing services
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20
Q

What are direct nonmedical costs?

A

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

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21
Q

What are indirect costs?

A

Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity b/c of premature mortality

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22
Q

What are intangible costs?

A

Pain and suffering
Fatigue
Anxiety

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23
Q

What is the Drummond classification of costs?

A

Health care sector costs
Other sector costs
Patient and family costs
Productivity costs

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24
Q

What are sources of cost?

A 
Payers
Third part vendors
Providers
Biomedical, biopharmaceutical and pharmaceutical companies
Patient and caregiver reported
Tertiary data sources
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25
Q

Who are payers?

A

Managed care providers
Pharmacy benefit managers
Medicare
Medicaid

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26
Q

Who are third party vendors?

A

Purchase proprietary data from variety of sources and aggregate
Group purchasing organizations
Management companies

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27
Q

Who are providers?

A

Health systems
Individual providers
Pharmacies, hospitals, etc

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28
Q

Who are tertiary data sources?

A

Micromedex contains Red Book Prices (AWP)

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29
Q

What are types of hospital costing?

A

Micro-costing
Case-mix group
Disease specific per diem (daily cost)
Per diem

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30
Q

What is micro-costing?

A

Each component of resource used quantified, measured, valued

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31
Q

What is case-mix group?

A

Gives cost for each category of case/type of patient

Accounts for LOS

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32
Q

What is disease specific per diem?

A

Gives mean daily cost for treatment of certain diseases

33
Q

What is per diem hospital costing?

A

Mean daily cost for all patients

34
Q

Which type of costing is the most precise?

A

Micro-costing

35
Q

An ambulance cost is what type of cost?

A

Direct medical cost

36
Q

Improved health after treatment would be what type of cost?

A

Intangible

37
Q

What is the main goal of tracking costs and outcomes?

A

Not to mislead policy maker

38
Q

When do we use short-term tracking?

A

In hospital - to discharge

39
Q

When do we use medium term tracking?

A

Payer - 1-5 years

40
Q

When do we use long term tracking?

A

Patients - lifetime

41
Q

What are the two types of differential timing costs?

A

Cost standardization-past costs to present

Discounting-future costs to present

42
Q

What is a short term discounting cost?

A

< 1 yr, really no need

43
Q

What is a longer-term tracking discounting cost?

A

1+ year

44
Q

Why do we discount/standardize?

A

Inflation - $ today worth more dollar in future

People would rather have certain benefit today than one in future

45
Q

What is the ISPOR equation for discounting?

A 
PV = FC x DF (n,r)
PV = present value
FC = future costs
DF = discount factor
n = number of years
r = discount rate
46
Q

What are the types of PEC analysis?

A

Cost-minimization
Cost-effectiveness
Cost-benefit
Cost-utility

47
Q

What are the costs and outcomes of cost-minimization?

A 
Costs = monetary units
Outcomes = assumed to be equivalent
48
Q

What are the costs and outcomes of cost-effectiveness

A 
Costs = monetary units
Outcomes = naturals units (life years saved)
49
Q

What are the costs and outcomes of cost-benefit?

A 
Costs = monetary units
Outcomes = monetary units
50
Q

What are the costs and outcomes of cost-utility?

A 
Costs = monetary units
Outcomes = Quality-adjusted life years
51
Q

What is the most common type of PEC analysis?

A

Cost-effectiveness

52
Q

When is a cost-effectiveness analysis used?

A

Limited budget and have range of options w/in a field

53
Q

How must the outcomes compare in a cost-effectiveness analysis?

A

Outcome is same unit

54
Q

What does a cost-effectiveness analysis compare?

A

Costs and consequences of two alternative treatments

55
Q

What is the calculation for cost-effectiveness?

A

ICER (incremental cost-effectiveness ratio)
(Cost1 - Cost2) / (Outcome1 - Outcome 2)
1 = new drug
2 = comparator

56
Q

When are interventions said to be cost-effective?

A

Less expensive AND more effective
Less expensive AND at least as effective
More expensive AND more effective

57
Q

What intervention is said to not be cost effective?

A

Higher cost and less effective

58
Q

When is an ICER positive?

A

New tx more expensive AND more effective
New tx less costly and less effective
Generally want smaller ICER

59
Q

When is an ICER negative?

A

New tx less costly and more effective

New tx more costly AND less effective

60
Q

When are cost-effectiveness analysis most applicable?

A

Comparing costs/outcomes of 2+ alternative HTN med

Compare 2+ alternative programs to prevent mortality

61
Q

What is a surrogate outcome?

A

Intermediate
Easy to measure/obtain
Needs to be related to hard outcome

62
Q

In a CEA, what should be included in the methods?

A

Explicit description of costs/consequences
Perspective analysis
Methods and sources of data

63
Q

What are limitations to ICER?

A

Relatively small positive ICER driven by small increase in cost OR large gain in effectiveness
Conveys limited information to policy-makers

64
Q

What do negative ICER scenarios represent?

A

New medication/service dominant
OR
New medication/service being dominated

65
Q

What are the parts of QALY?

A

Life gained (mortality)
AND
Quality of that life gained (morbidity)

66
Q

When should a cost-utility analysis be used?

A

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

67
Q

What are problems with CUA?

A

Most difficult/ time-consuming/ expensive economic evaluation

68
Q

How is QALY usually measured?

A

Years

69
Q

What is the scale for QALY?

A

Anchored on scale from 0 (death) to 1 (perfect health)

Can be adjusted to reflect states worse than death (< 0)

70
Q

What is the focus of QALY?

A

Health states

71
Q

How is QALY calculated?

A

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

72
Q

How do we obtain utility weights?

A

Utility is preference
Through literature
Direct measurement from patients/general public

73
Q

What are the 3 methods for measuring utility?

A

Standard gamble (SG)
Time trade-off (TTO)
Visual analog scale (VAS)

74
Q

A CUA is a type of what other analysis?

A

CEA

75
Q

What is the SG based on?

A

Utility theory

76
Q

How many alternatives are available in a standard gamble?

A

2

77
Q

What is alternative 1 in a standard gamble?

A

Tx w/2 outcomes:

  • Returned to perfect health and lives for additional x years
  • Patient dies immediately
78
Q

What is alternative 2 in a SG?

A

Certain outcome of chronic state i for life

79
Q

How is SG probability manipulated?

A

Until subject indifferent b/t two alternatives which is preference score

Pharmacoeconomics (5 decks)

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