Lecture - Health Economics Flashcards
Health system objectives
- efficiency: getting maximum health benefit for scarece health dollars
- equity: notion of fairness or justice
Opportunity cost
- the benefits forgone when a decision is made to use a resource one way, instead of the next best alternative way
- costs are linked with benefits
- economic evaluations are how we operationalise the opportunity cost principle
3 components of economic evaluation
- choice: intervention/comparators
- resources: costs
- outcomes: benefits
Cost minimisation analysis
- outcomes are equivalent between interventions
- interested in least costly intervention
Cost effectiveness analysis
- outcomes measured in natural units
- lives saved, life years saved, cases detected, hospitalisation prevented
Cost utility analysis
- outcomes are multidimensional health index
- quality adjusted life years
Cost benefit analysis
- outcomes measured in moneraty units
In screening for CRC, should we do A or B?
- cost minimisation if outcomes identical
- cost effectiveness otherwise
Should we do more CRC or breast cancer?
- cost effectiveness if outcomes are unidimensional
- cost utility otherwise
Is it worthwhile addressing CRC screening?
- cost benefit analysis
Health system objectives
- efficiency
- equity
- inequality
- inequity
- may be necessary to tolerate or even create inequalities in access to health care in order to reduce inequities
Horizontal vs vertical equity: positive discrimination
- horizontal: similar circumstances treated similarly
- Vertical: different treated differently
Incremental cost-effectiveness ratio
ICER = (total cost screening - total cost no screen)/(total benefit screening - total benefit of no screen)
Health outcomes
1) CEA: cost per life year saved
- valuation of outcomes is implicit
- fewer hospitalisations is better than more
- more lives saved is better than fewer
2) CUA (cost per QALY gained)
- valuation is not implicit
- preferences play a role
- need explicit evaluation of how good or bad a health state it
QALY, survival and QOL
- QALYs attempt to evaluate impact of trade-off between QOL and survival
- summarises net effect of treatment on QOL and survival
- idea is to equate a given outcome to a shorter period of survival spent in full health
- QOL adjustment weight applied to survival to get QALY
