Health economics lec and workshop

Question 1

What is meant by scarcity costs?

Answer 1

Allocating funding when their is limited resources, gain for one resource often results in loss for another
The NHS has a limited budget and an ageing populations, patients have high expectations and always expect more

Question 2

What is meant by efficiency cost in terms of the NHS?

Answer 2

The acts of saving money by changing a process or product to act in a certain way

Question 3

What is meant by an opportunity cost in context of the NHS?

Answer 3

Every treatment that is funded might mean that another treatment is not funded
Who should decide what patient group is in more need of treatment.

Question 4

What is the purpose of an economic evaluation by NICE?

Answer 4

Promote efficient use of healthcare resources
Maximise total benefit derived from finite resources available
Compares the costs and consequences of new and existing treatment
Has consistent and fair methods for all disease types
Has methods to consider societal preferences

Question 5

What is the incremental approach to economic evaluation?

Answer 5

Comparison of option A and option B, considers the costs and differed in consequences ( both positive and negative)

Question 6

What is modelling in terms of economic evaluations?

Answer 6

A mathematical repressentation of a disease pathway
Combines input from multiple sources to estimate cost effectiveness
For example may include, unit cost, mortality, resource use, diagnostic accuracy etc.

Question 7

What are the benefits of model over a clinical trial in calculating the cost of a treatment?

Answer 7

Models extend trial length
Is less expensice to calculate
Can add any outcome considered appropriate
Can include an infinite number of comparators.
Allow us to explore uncertainty.

Question 8

What are the different categories of cost from an intervention?

Answer 8

Direct costs
1) health and social care service and resource use cost NICE
2)Non- health service resource use such as patient transportation and informal care

Indirect costs - wider cost implications to society such as loss of production

Question 9

What are the different outcomes from an intervention?

Answer 9

Proxy outcomes - an indirect measure of a desired outcome but is highly correlated with outcome, e.g change in cholesterol level
Condition specific measures
Generic Measures
Natural units - blood pressure, HR etc

Question 10

How is QoL determined by NICE in order to calculate a QALY?

Answer 10

Use Euro-QoL 5 dimensions
Considers mobility, self care, usual activities, pain/discomofrt, anxiety/depression
Each dimension has three options for a multiple choice answer, each of the three answers is associated with a score.
An equation converts the combined score into a utility value
Utility value of 1 indicates perfect health, 0 death and less than 0 is worse than death.

Question 11

How does NICE calculate QALYs gained during economic evaluation?

Answer 11

Use QoL score to calcuate QALYs
QALYS gained = QALY with treatment - QALY without treatment

Question 12

What does the value of an ICER indicate?

Answer 12

How much addition resource is required for an additional unit of health
This unit of health used by NICE is a QALY

Question 13

What factors can be applied if an ICER score is too high but NICE would like to approve the drug?

Answer 13

Patient Access Schemes
Cancer Drug FUnd
Innovative Medicine Fund
Decision modifiers

Question 14

What is meant by a cost effectiveness plane?

Answer 14

Horizontal plot for effectiveness of treatment
Vertical plot originating from the middle of the horizontal line for cost. Intersection of both lines has value of zero
A diagonal line is then drawn (upward slant to right) help indicate what treatments would be approved (often is below the line)

Question 15

What is meant by a dominated and dominant treatment in NICE economic evaluation?

Answer 15

Dominated - more costly and less effective
Dominant - more effective and less costly.

Question 16

What degree of uncertainty surrounds the use of a company evidence in NICE economic evaluation?

Answer 16

A company may spend a lot of time and effort developing a model
Specially select expert advice and synthesise the best available data - give the best possible outlook and ICER value

Question 17

How factors affect our certainity around an ICER value?

Answer 17

Heterogencicity - value may changed when considereding different values or subgroups
Structural uncertainty - decision different with a different analysis for example a different comparator or model
Parameter uncertainty - change if different input values are used.

Question 18

How can we overcome parameter uncertainity?

Answer 18

Use a deterministic sensitivity analysis
Will show which inputs will have the greatest effect on the ICER score, look into variation into this variable, ensure suitable value is used to calculate a more accurate ICER.
Or create multiple ICERs using different values for this variable in order to accommodate for uncertainty.

Question 19

What are the different types of economic evaluation completed by NICE?

Answer 19

Cost effectiveness analysis
Cost utility analysis
Cost benefit analysis

Question 20

What is a cost effectiveness analysis?

Answer 20

Focus on the cost of achieving one outcome e,g survival rates or reduction in symptoms
Results are in terms of cost per unit effect (normally natural or physical units)
Decision rule: dominance or cost-effectiveness ratio compared to existing treatment

Question 21

What is a cost-utility analysis?

Answer 21

Most consider the quality of life
Uses QALYs
Can compare across treatment areas
results are often additional cost in terms of QALY gained
Required by NICE in order to make a decision

Question 22

What is a cost benefit analysis?

Answer 22

Measure benefits in monetary terms.

Question 23

What is equity why is it used by NICE?

Answer 23

Fiarness in distribution of health care and health outcomes
Attempt to address equitable concerns requires additional analysis outside cost benefit
NICE does this to ensure equal distribution of health resources.

Question 24

What is meant by horizontal equity?

Answer 24

People with equal health needs recievie equal access to treatment irrespecitve of demographics and barriers
Factors that effect this are geography, waiting times, patient information

Question 25

What is meant by vertical equity?
What factors effect this?

Answer 25

Indivudla with unequal needs should be treated according to their differential need
Obvious but often operationally difficult
How unequal do conditions need to be in order to purse equity objectives?

Question 26

What are the different types of rationing in relation to health care?

Answer 26

Rationing - are the ways in which access to health care is limited
This may be explicit such as efficiency rationing by NICE
This may be implicit such as denial (ineligible for treatment, post code lottery means inaccessible), delay (waiting list), deterrence, dilution (reduce time with patients)