Lecture 7 - CUA and CMA

Question 1

what does CUA stand for?

Answer 1

Cost-utility analysis

Question 2

what is the input/output unit of CUA

Answer 2

input - monetary unit
output— value or worth of health status or improvement in health status (QALY gained)

Question 3

QALY measures both ____ and ____

Answer 3

quantity of life and quality of life

Question 4

the advantages/disadvantages of CUA are similar to the advantages/disadvantages of….

Answer 4

CBA

Question 5

Name 2 advantages of CUA

Answer 5

-different types of health outcomes can be compared
-diseases with multiple outcomes of interest can be compared

Question 6

What are 2 DISADVANTAGES of CUA?

Answer 6

-no consensus on how to measure utility
-difficult to determine an accurate utility or QALY value— more of a “rough estimate”

Question 7

What are the 4 steps in calculating QALYs?

Answer 7

1. Develop description of each disease state or condition of interest
2. choose method for determining utilities
3. choose subjects who will determine the utilities

4.multiply utilities by length of life for each option to obtain QALYs

Question 8

what are 2 common methods used for determining utilities?

Answer 8

1. rating scale (RS)
2. Standard gamble (SG)

Question 9

describe what the rating scale method of measuring utility is

Answer 9

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

Question 10

what is the easiest and simplest way to calculate utility?

Answer 10

the rating scale

Question 11

explain what the standard gamble method of measuring utility is

Answer 11

each subject is offered 2 possible alternatives

1. treatment with 2 possible outcomes (normal health or immediate death)
2. 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

Question 12

what are some advantages of using the rating scale as a method of determining utility?

Answer 12

-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

Question 13

What is a disadvantage to using the rating scale?

Answer 13

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

Question 14

what is the advantage of using the standard gamble to determine utilities?

Answer 14

it is the “gold standard”

Question 15

what are some disadvantages to using the standard gamble method to determine utilities?

Answer 15

-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

Question 16

what is the advantage/disadvantage for using the patient themselves to determine utilities

Answer 16

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

Question 17

what is the advantage/disadvantage to using health care professionals to determine utilities

Answer 17

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

Question 18

what is the advantage/disadvantage of using the general population (society) to determine utilities?

Answer 18

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

Question 19

how is QALY calculated?

Answer 19

years of life saved * utility for each year of life saved

Question 20

what does CMA stand for?

Answer 20

cost-minimization analysis

Question 21

what is the input/output of CMA?

Answer 21

input = monetary unit

output = NONE(all groups assumed to have same outcome)

Question 22

CMA is only used when….

Answer 22

it appears that the treatments are identical in their effectiveness

Question 23

CMA measures and compares…

Answer 23

input costs

Question 24

give 2 examples of when we would use CMA

Answer 24

1. Comparison of generic equivalents of drugs of the same entity
2. measuring costs of receiving the same medication in different settings (hospital vs home)