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HES > Health Economics > Flashcards

Health Economics Flashcards

1
Q

Scarcity of resources is what health economics is concerned with what is the purpose behind economic analyses

A

It helps decision makers faced with choices concerning resource scarcity

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2
Q

2 stances concerned with economic analyses

A

Normative stance: indicate the nature of the resource allocation decision that should be followed if objectives need to be me

Positive stance: seek to predict observable factors and provide info on the likely costs and benefits associated with alternative courses of actions weighing up costs and benefits of treatment

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3
Q

Opportunity cost

A

Is what you can no longer afford because of what you spent on something else

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4
Q

Technical efficacy

A

Producing an output without wasting scarce resources. Meeting a given objective At the least cost - cheapest treatment

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5
Q

Allocative efficacy -

A

The output that best satisfies the consumers wants and needs

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6
Q

Key objectives of economic analysis -

A

To promote the efficient use of health care resources and to ensure the maximum total benefit is derived from the finite sources available.

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7
Q

Define economic evaluation:

A

A comparative analysis of alternative courses of action in terms of both costs and consequences

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8
Q

Types of economic evaluation

A 
Cost consequence analysis
Cost effectiveness analysis 
Cost minimalisation analysis
Cost utility analysis 
Cost benefit analysis
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9
Q

Incremental approach

A

Answers what are the cost and consequences of treatment A vs treatment B
Estimates the additional cost per unit of outcome compared one treatment to the other

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10
Q

Marginal benefit

A

Is the increase in benefit as a result of increasing production by one additional unit

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11
Q

Marginal cost

A

The increase in cost as result of increase output by one additional unit

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12
Q

Cost effectiveness analysis

A

Gives consequences in the most appropriate natural or physical units
Cost per unit effect
Lives saved/ complications avoided/ symtpm free days/ cancers detected
Decision rule: dominance or CE ratio.

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13
Q

Incremental cost effectiveness ratio (ICER)

A

Difference in cost/difference in consequences
Gives a value per additional unit benefit between two treatments
Cost B - cost A/ benefits B - benefits A

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14
Q

Cost utility analysis

A

Outcomes measured in QALYS gained - combine QOL and years
Can compare across treatment areas
Decision rule: dominance or CU ratio
Required by NiCE
Use ICER to measure QALYS as consequences

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15
Q

What is a decision rule

A

nICE
New therapies are effective is the cost per QALY is less than 20000£
20000-30000 take other factors into account

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16
Q

Equity

A

Doesn’t use QALYS or utility but focuses on fair distribution of finance, health, use of health care, and access to health care

17
Q

2 types of equity

A

Horizontal equity - equal treatment irrespective of demographics
Equal access for equal need
Barrier: geography, waiting times, patient info, differences in units of measurements
Vertical equity - treat according to differential need
How unequal do conditions need to be - chronic vs trivial complaints
Financing: unequal treatment through the ability to pay - progressive taxation

18
Q

Measurement of outcomes and costs we use in our economic evaluation where are they from?
Outcomes

A

Clinical outcomes can be measured in natural units - BP, cholesterol level
Life years gained
Look at short term and long term outcomes
Advantages:
Often measured in clinical studies, easily understood
Limitations:
Lack of comparability across diseases
Multiple outcomes ?
-> measure cost vs impact of life expectancy and QOL

19
Q

Valuing health - QALYS

A

Combination of QOL and length of life in a single unit
QOL: value of health states - questionnaire between 0 same as death and 1 which is healthy
QALY: sum(length of life) x (QOL)

20
Q

What are the problems with QALYS

A

Doesn’t matter who is benefitting
Questions are insensitive
End of life treatments don’t work
Discrimination against people with fewer QALYS to gain such as the elderly
Benefits to the Carer and family are ignored
QALYS ignore patient benefits such as control, reassurance, knowledge, satisfaction and capability

21
Q

Health and social services cost:

A

Primary care costs: GP and practice nurse visits, other health care professionals

Secondary care costs: a&e attendance, outpatients, inpatient stays, surgery, tests

Social services: nursing home costs, home help, home adaptations,

Patient and Carer costs: time and transport OTC meds, private healthcare, paid carers

Indirect costs: cost due to lost production
Unable to work due to health and disability pm time off work for illness, reduced productivity

22
Q

NICE parts of it: centres

A

Centre for health technology and evaluation -TECHNOLOGY APPRAISALS
Centre for clinical practice - CLINICAL GUIDELINES
Centre for public health - PUBLIC HEALTH

23
Q

NICE parts of it: directorates

A

Communications
Health and social care
Evidence resources
Business planning and resources

24
Q

Technology appraisal programmes:

A

Based on explicit criteria and informed by an independent body of evidence
Technologies to be appraised selected by DoH and approved by Secretary of State
Should be a mix of new and old technologies
Aims to remove investment from technologies which are not cost effective
Usually dominated by new and expensive drugs

25
Q

How a technology review happens - multiple technology review

A 
Referral, submissions and assessment 
Consultation on evidence 
1st committee meeting -> preliminary recommendations 
Consultation on these recommendation 
2nd committee meeting -> final guidance 
Appeal or not 
Publication
26
Q

Who are these committees made up of

A

Medics, HCPs, economists, managers, lay members, manufacturers

27
Q

Single technology appraisal

A 
Evidence review 
fact checking 
1st committee meeting prelim recommendations 
Consultation on this 
2nd com meeting final guidance 
Appeal or Not 
Publication
28
Q

Impact of NICE decision making

A

Must be funded within 3 months of positive guidance being issued
Approval means right to prescribe
Little impact of prescribing patterns after approval of new drugs

29
Q

National committee for screening

A

Same as last time - added make sure enough money for it to continue not just one time only thing

30
Q

What is the cancer drug fund

A

Bypasses appraisal process

Cancer drugs

31
Q

Patient top up care

A

Patients can pay for extra care that NICE found not to be cost effective never used to be a lowed now it is

32
Q

What does QALY stand for

What does LYG stand for

A

Quality adjusted life year

Life years gained

HES (8 decks)

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