Health Economics Flashcards
Scarcity of resources is what health economics is concerned with what is the purpose behind economic analyses
It helps decision makers faced with choices concerning resource scarcity
2 stances concerned with economic analyses
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
Opportunity cost
Is what you can no longer afford because of what you spent on something else
Technical efficacy
Producing an output without wasting scarce resources. Meeting a given objective At the least cost - cheapest treatment
Allocative efficacy -
The output that best satisfies the consumers wants and needs
Key objectives of economic analysis -
To promote the efficient use of health care resources and to ensure the maximum total benefit is derived from the finite sources available.
Define economic evaluation:
A comparative analysis of alternative courses of action in terms of both costs and consequences
Types of economic evaluation
Cost consequence analysis Cost effectiveness analysis Cost minimalisation analysis Cost utility analysis Cost benefit analysis
Incremental approach
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
Marginal benefit
Is the increase in benefit as a result of increasing production by one additional unit
Marginal cost
The increase in cost as result of increase output by one additional unit
Cost effectiveness analysis
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.
Incremental cost effectiveness ratio (ICER)
Difference in cost/difference in consequences
Gives a value per additional unit benefit between two treatments
Cost B - cost A/ benefits B - benefits A
Cost utility analysis
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
What is a decision rule
nICE
New therapies are effective is the cost per QALY is less than 20000£
20000-30000 take other factors into account
Equity
Doesn’t use QALYS or utility but focuses on fair distribution of finance, health, use of health care, and access to health care
2 types of equity
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
Measurement of outcomes and costs we use in our economic evaluation where are they from?
Outcomes
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
Valuing health - QALYS
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)
What are the problems with QALYS
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
Health and social services cost:
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
NICE parts of it: centres
Centre for health technology and evaluation -TECHNOLOGY APPRAISALS
Centre for clinical practice - CLINICAL GUIDELINES
Centre for public health - PUBLIC HEALTH
NICE parts of it: directorates
Communications
Health and social care
Evidence resources
Business planning and resources
Technology appraisal programmes:
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
