Lecture 7 - CUA and CMA Flashcards
what does CUA stand for?
Cost-utility analysis
what is the input/output unit of CUA
input - monetary unit
output— value or worth of health status or improvement in health status (QALY gained)
QALY measures both ____ and ____
quantity of life and quality of life
the advantages/disadvantages of CUA are similar to the advantages/disadvantages of….
CBA
Name 2 advantages of CUA
-different types of health outcomes can be compared
-diseases with multiple outcomes of interest can be compared
What are 2 DISADVANTAGES of CUA?
-no consensus on how to measure utility
-difficult to determine an accurate utility or QALY value— more of a “rough estimate”
What are the 4 steps in calculating QALYs?
- Develop description of each disease state or condition of interest
- choose method for determining utilities
- choose subjects who will determine the utilities
4.multiply utilities by length of life for each option to obtain QALYs
what are 2 common methods used for determining utilities?
- rating scale (RS)
- Standard gamble (SG)
describe what the rating scale method of measuring utility is
line on a page with scaled markings with perfect health (100) on top and death (0) on bottom
different disease states are described to subjects and they place their preferences (utilities) on the RS by marking an X
what is the easiest and simplest way to calculate utility?
the rating scale
explain what the standard gamble method of measuring utility is
each subject is offered 2 possible alternatives
- treatment with 2 possible outcomes (normal health or immediate death)
- Certain outcome of a chronic disease state for life
probability of normal health for alt 1 is varies until the subject is indifferent between alternative 1 and 2
what are some advantages of using the rating scale as a method of determining utility?
-many diseases can be described to each subject
-can be conducted without face to face interaction via a questionairre
-people are familiar with indicating preference on these types of scales
-less cognitively demanding
What is a disadvantage to using the rating scale?
may be biased in that people do not tend to cluster their values at the extreme ends of the scale but to spread them throughout
what is the advantage of using the standard gamble to determine utilities?
it is the “gold standard”
what are some disadvantages to using the standard gamble method to determine utilities?
-more difficult for participants
-few disease states can be “cured” by an intervention that brings them back to “normal health”
-need more resources to administer
-more time consuming
what is the advantage/disadvantage for using the patient themselves to determine utilities
advantage: the patient may understand the effects of the disease better than the general public
disadvantage: may provide biased view of their own disease compared with other diseases
what is the advantage/disadvantage to using health care professionals to determine utilities
advantage: could provide good estimates because they understand various disease
disadvantage: may not rate discomfort and disability as seriously as patients or the general publiv
what is the advantage/disadvantage of using the general population (society) to determine utilities?
based on economic theory, the viewpoint of the analysis SHOULD be from society
but there is a disadvantage— the general publiv may not be famililar with the complex outcomes associated with each disease state or outcome and short descriptions may not encompass all of the issues related to the disease state
how is QALY calculated?
years of life saved * utility for each year of life saved
what does CMA stand for?
cost-minimization analysis
what is the input/output of CMA?
input = monetary unit
output = NONE(all groups assumed to have same outcome)
CMA is only used when….
it appears that the treatments are identical in their effectiveness
CMA measures and compares…
input costs
give 2 examples of when we would use CMA
- Comparison of generic equivalents of drugs of the same entity
- measuring costs of receiving the same medication in different settings (hospital vs home)
