Health Economics

Question 1

Definition of economic evaluation

Types of cost: Direct and Indirect

Answer 1

Comparative analysis of alternative courses of action in terms of both cost and consequences.

Direct
Health and social services resource use- treatment, drugs, in-patient stay
Non- health service use- patient transport, informal care

Indirect
Wider cost implications- lost production

Question 2

QALY formula

What does it combine?

How is QoL measured?

Questionnaire used to self assess QoL?
What are the 5 dimensions within?

QUALYs gained=

Answer 2

QALY = { ((length of life) x QoL)
Quality and length of life
Max value of 1 (perfect health) and value of 0 is equivalent to death

EQ-5D -> out of 3 in each dimension

1) Mobility
2) self care
3) usual activities
4) pain + discomfort
5) anxiety/ depression

The difference in QUALYs between two interventions

Question 3

Cost- effectiveness plane
Less effective + more expensive =
More effective + cheaper =
Somewhere across the middle =

Answer 3

Dominated
Dominant
ICER -> Incremental Cost- Effectieness Ratio

Question 4

ICER Formula

3 main types of Economic evaluation

1) 1,2 decision rule, results measured in
2) 1,2 decision rule, results measured in
3) 1,2

Answer 4

New cost-current cost/-(new QUALY-Current QUALY)

1) Cost- effectiveness analysis (CEA)
Must choose one single outcome eg. Cost for inc. survival
Consequences are in natural or physical units
Decision rule: dominant or dominated plane
Results in cost per unit effect eg cost per life saved

2) cost- utility analysis (CUA)
Measured in QUALYs! 
Easy to compare treatments 
Decision rule: dominance or CU ratio 
Results always cost per QUALY gained 

3) Cost- benefit analysis
Used with money + costs
Measured in mandatory terms

Question 5

NICE believe a new rear,eg. I’d cost effective if….

Other factors considered if between… such as….

Equity
What is it?
2 types:

2 types of rationing
1) 4 Ds
2)

Answer 5

Cost per QUALY is LESS THEN £20,000
£20,000- £30,000 such as cancer treatments and rare conditions

Equity:
Fairness in distributing health care and health outcomes

1) Horizontal equity-> those with equal needs receive equal access to health care irrespective of demographic

2) vertical equity -> those with unequal need should be treated in order of differential need.
It’s obvious but difficult to implement

Rationing 
1) implicit rationing 
Denial- ineligibility/ postcode lottery  
Delay- waiting lists 
Deterrence- side effects 
Dilution- dec. time with patients 

2) explicit rationing
Efficiency side via NICE