Intro To HC Economics Flashcards
LO2: consid advs and disadvs of using QALYs as method of resource alloc.
-effectiven meas can be used in range of settings to comp cost effectiven.
Life years gained- but only where surv is main outcome.
Quality adjusted life years (QALYs)- composite or surv and QoL.
Allows broad compar across diff progs.
Adjust life expec for QoL:
1 yr of perfect health of one person= 1 QALY.
Assumes that 1 yr perfect health= 10 yrs with QoL of 0.1 perfect health.
1 QALY= 2 years at 50% QoL for 1 person.
1 QALY= 6 mnth of healthy life for 2 people.
QoL meas using EQ-5D Qairre gives 1 outcome.
-total cost of tx/ total QALYs by a tx= cost per QALY gained.
-alts to QALYs:
Health year equivs, saved young life equivs, disabil adjusted life years.
NICE uses QALYs.
-how NICE decides-
Technology appraisals- clinical and cost effectiven.
Proc/consultation- ID topics. Scoping (NICE/DOH). Assessm by HTA assessm grps. Appraisal by committee.
-NICE integs QALY with price of tx using incremental cost effectiven ratio (ICER). ICER represents change in cost rel to change in health status. Res is cost per QALY fig.
Committ chooses most plausible ICER. Below 20K per QALY tech norm approved. 20-30K judgements take acc of- deg of uncert, if change in HRQL is adeq captured in QALY, innervat that adds distinctive benefs not capt in QALY. Above 30K needs an incr stronger case.
-NICE and legitimacy:
May be repres by pt grps or pharm companies. CCGs prioritise NICE approved intervens somet with unintended conseqs. Concerns about politic interf.
-CRITICISMS of QALYs:
Values they embody controv.
Dont distrib resource acc to need, only benefs gained per unit cost.
May disadv comm conds.
Tech probs with their calcs.
QALYs may not embrace all dimens of benef, vals exp by experim subjects may not be representative.
QALYs dont assess impact on carers or fam.
-RCT ev not perfect:
Comparison therapies may differ, length of foll up, atypical care and pts, lim generalisabil, sample sizes.
Stat modelling can address some probs and areas or uncert.
-rationing diffic but necess-
No longer implicit by indiv clinicians. Now explicit but diffics in ID princips that should gov decis making. QALYS offer way of rationing but are criticised. NICE proc become more transpar and centralised but often faces legitimacy probs.
LO1: expl and disting btw cost effectiven, cost benef, cost utility, and cost minimisat analysis.
-4 types econ eval to comp costs and benefs:
All consid costs but diff extent of try meas and value conseqs/benefs.
1) cost minimisat anal:
Outcomes assumed equiv. Meas costs so only input. Not often relev as outcomes rarely equiv.
Eg say all hip prosthesis impr mobility equally and choose cheapest.
2) cost effectiveness anal:
Comp drugs or intervens with comm health outcome. Comp in cost per unit outcome. If costs and benefs higher for one, then clac how much extra benef for the extra cost. Is it worth it?
3) cost benef anal:
All inputs and outputs valued in monetary terms. Can allow comparis with intervens outside HC. Methodological diffics eg putting monetary val on non monetary benefs eg lives saved. Willingness to pay often used but is problematic.
4) cost utility anal:
Type of cost effectiven anal. Foc on qual of health outcomes produced or foregone. Freq use QALY measure. Intervens comp in cost per QALY terms.
Other
-scarcity= need outstrips resources. Prioritisat inevit.
-efficiency= getting most out of lim resources.
-equity= extent to which distrib of resources is fair.
-effectiveness= ext to which an interven prods desired outcomes.
-utility= val an indiv places on a health state.
-opp cost= once you have used a resource in one way, you no longer have it to use in another way. Opp cost of a new tx is the val of the next best alt use of those resources. Meas in benefits foregone. Form most effic mix of services that gen biggest aggreg benef. But biggest aggreg benef diffic to define?
-tech efficiency- most effic way of meeting a need, given avail money.
-allocative efficiency- choosing btw many needs to be met.
-econ eval- comp of resoruce implics and benefs of alt HC deliv. Can make decis more transpar and fair. Based on concepts of scarcity and sacrifice, efficiency, opp cost, utility. Comps inputs and outputs of 2 options.
-How meas costs- ID, quantify and val resources needed.
Categs:
Costs of HC services.
Costs of pt time.
Costs assoc with care giving.
Other costs assoc with illness.
Econ costs to employers, other employees and rest of society.
-diffic to meas benef of impr health. Categs:
Impact on health status (surv, QoL).
Savings in other HC resources if pts health state imprs.
Impr productivity of pt/fam members.
-sensitiv anal check effs of assumps.
Discounting calc present vals of inputs and outputs which accrue in fut.
