Lecture 14 Flashcards
Economic analysis
Defines choices in resource allocation
- Cost minimization
- Cost effectiveness
- Cost utility
- Cost benefit analysis
Cost minimization analysis (part of economic analysis)
Directly compares effect of interventions known or assumed to be identical. Ex: brand vs generic
Cost effectiveness analysis (part of economic analysis)
Compares effect of interventions expressed in one main variable of natural units. Ex: life. Years gained.
Cost utility analysis (part of economic analysis)
Compares interventions whose effect has two or more important dimensions in utility units like QALYs.
Cost benefit analysis (part of economic analysis)
Compares different interventions for different conditions in monetary units. Ex: decision to fund heart transplantation or stroke rehabilitation program.
Economic analysis. 3 types of costs
Direct- consumables, doctor’s, staff
Indirect- work lost, unpaid work
Intangible- pain and suffering
Economic analysis. 3 types of benefits
Economic- preventative care, return to work
Clinical- improved function, symptom relief (myopes)
QoL- Enhancement of life.
Vision quality of life index
Focus groups on visually impaired persons key concepts. Physical well being Social well being Emotional well being Independence Self-actualization Planning and organization
Generally, a weighted index of preference is determined on scale from 0 (death) to 1 (perfect health). When this value is known over time, it can be used to compute QALYs
QALYs
Utility value x length of time gained.
or
Health state preference value x time pt is likely to be in that health state
Can be used in cost-utility analysis
QALYs can be used in which type of analysis
Cost utility
Health state preference value
Value a healthy person places on a particular deterioration health, or sick person places on return to health. More useful to medical economists. Continuous scale.
Healthy–> deterioration
Sick –> healthy
Time trade off measurement
patient estimates how many remaining years in full health they are willing to sacrifice to be cured.
Ex: would sacrifice 10 years to be fertile.
Standard gamble measurement
Patient chooses between A or B.
A: remain in particular state of health
B: Gamble on pursuit of risky therapy given that there are odds of being cured and odds of being killed by intervention.
Odds are varied to find a point patient decides gamble is not worth the risk. Subjective measurement.
can either remain impaired, or gamble on tx and be cured or die.
What does QALY stand for
Quality adjusted life years
Incremental cost effectiveness ratio (ICER)
Used to compare older, less expensive therapy with newer, more expensive therapy.
(Cost new - Cost old)/ effectiveness new - effective old
If cost effectiveness is high, that means
we are willing to pay more money for it.
Cost consequences analysis
Expresses different outcomes in terms of natural units. Eg months of survival, legs amputated.
Individuals assign their own values to differing interventions. How they value different forms of treatment.
Qualitative(interpretive) researches seek to
Study things in their natural setting. Use holistic perspective.
General hypothesis uses deductive reasoning, which is
General principle, then apply to special case.
Inductive reasoning uses inductive reasoning
Special case applies to general principle.
Several specific examples used to arrive at general conclusion.
Qualitative (interpretive) research
Validity/qualitative strength: Closeness to truth
Triangulation: Combo of methods improves validity of findings.
Reflexivity assesses influence a researchers perspective has on the data. Observer bias.
Inter-rater reliability: more than 1 researcher analyses data and reaches same conclusion.
Progressive focusing: Modify research question in light of findings
Purposive sample: Seek subjects with characteristics you want to study.
Thematic analysis: Come up with ideas, then group. Constant comparative method to refine emerging theory.
Difference between research question with qualitative research vs RCT
Qualitative research: Can modify research question in light of findings generated along the way in an iterative approach.
RCT: Now allowed to change mind. Must follow protocol.
Questionnaire research must require which 2 components
Must have survey instrument (questionnaire) with items that contain a stem + options.
Validated questionnaire
Make sure it measures what it claims to measure.
Enhances credibility.
Required for all new questionnaires.
When are questionnaires not appropriate
Ex: prevalence (burden of disease) or professional behaviors.
How to analyze questionnaire research (sample types): Stratified random sample
Break samples into groups based on similarities then randomly select.
How to analyze questionnaire research (sample types): Snowball sample
Not random. Select a small group of subjects who invite others to participate.
How to analyze questionnaire research (sample types) Opportunity/convenience sample
Selecting only subjects who have opportunity to participate- those easily accessible. Very biased.
SQUIRE
A questionnaire that promotes excellence in healthcare improvement reporting.
