L15

Question 1

Which different groups of society may have costs of various HC choices imposed on them?

Answer 1

Society
Hospitals
Family carers
Health system
Primary care services

Question 2

3 steps to CUA cost estimations?

Answer 2

1) Identify resource use associated with the technology under assessment
2) Measure consumption of HC services
3) Value resource use by assigning unit costs (prices)

Question 3

What might we consider when identifying resource use associated with the technology under assessment?

Answer 3

What costs we are interested in:
Cost of treatment/tech/intervention itself
Cost due to consumption of other services (ie. additional Dr. visits)

Question 4

Example: what costs may need to be considered for chemotherapy?

Answer 4

medication, treatment administration, hospitalisations due to adverse events etc.

Question 5

How would one then measure the consumption of HC services in CUA? (2 ways)

Answer 5

Observing and recording use: routine sources (hospital records)

or could use observational studies (ie. follow a group of cancer patients and track their use of services)

Question 6

How would one then value the resource that has been measured in a CUA?

Answer 6

Using sources of prices such as NHS information centres or publications (eg. cost per visit to the GP)

Question 7

Equation for an Incremental Cost Effectiveness Ratio (ICER)?

Answer 7

ICER = (Cost(B)-Cost(A)) / (QALYs(B)-QALYs(A))

Question 8

What should prices be when valuing the resource that has been measured in a CUA?

Answer 8

GENERALISABLE (whatever that means)

Question 9

Draw the ICER diagram

Answer 9

see notes

Question 10

When will a CUA usually implement an intervention/technology?

Answer 10

When it falls below the maximum acceptable ICER

Question 11

See

Answer 11

example in notes (important)

Question 12

If one is in the Top-right quadrant of the ICER diagram, how is the decision often made?

Answer 12

By considering the maximum amount the government is willing to pay for an additional QALY (UK roughly £20-£30K) (also may be necessary to do in the B-L quadrant)

Question 13

How much is the QALY threshold in Netherlands, or Ireland?

Answer 13

Netherlands: 80K euros/QALY
Ireland: 45K euros

Question 14

CASE STUDY PROSTATE CANCER: What did the study look at?

Answer 14

Old men with prostate cancer deemed more likely to experience metastases (ie. pain and fractures)
Tf bone protecting agents (Zoledronic acid) could be added to the chemo but add to the cost!
Tf study looked at whether adding ZA to chemo was a cost-effective use of NHS resources?

Question 15

CASE STUDY PROSTATE CANCER: 2 groups?

Answer 15

chemo+ZA

chemo without ZA

Question 16

CASE STUDY PROSTATE CANCER: assessment process?

Answer 16

Used EQ-5D questions to assess outcomes, and costs also evaluated considering NHS resources

Question 17

CASE STUDY PROSTATE CANCER: results of the study? (cost? outcome? ICER?)

Answer 17

Determined ZA cost = £251 extra
Outcome of ZA: slight increase in QofL (+0.031)
TF ICER = £8005
less than the threshold in UK tf addition of ZA deemed good value for money!

Question 18

See

Answer 18

Hep. c case study (important!)