Measurement of Outcomes and Costs in Economic Analysis Flashcards
What assumption is made in economic evaluation?
- that distribution does not matter
- just as good to give 50 years of good QoL to one person as to give 10 ears to 5
- we are interested in the maximum total benefit from the budget
What does the costs and outcomes we measure depend on?
Depends of the perspective of our analysis - health service - public sector - patient - society Type of economic evaluation - CEA or CUA
What kind of clinical outcomes can we measure?
- measured in natural units
- proxy outcomes lead to further outcomes e.g. cancer detected or change in cholesterol levels
- condition-specific measures e.g. Roland Morris quesionnaire for back pain or CAT (COPD assessment test)
- generic measure e.g. life years gained
Give examples of short and long term outcomes in hypertension
short= reduced in blood pressure long = number of strokes/MIs, overall number of CV events, number of deaths
What are the advantages of clinical outcomes?
- often measured as part of clinical study
- easily understood/transparent to clinicians/decisino makers
What are the limitations of clinical outcomes?
- lack of comparability across different disease areas
- what does £ per unit reduction in mmHg actually mean?
- what if we have more than one outcome?
How are QALY’s calculated?
What does 1 mean?
What does 0 mean?
- total(length of life x QoL)
1 = perfect health
0 = death
Where is the information for QALYs collected from?
- life years: life tables and treasure as well as deaths recorded in stay
Quality of life - value judgement
- questionnaires
- direct measurements from health state description
- published values in literature
What questionnaire is used to assess quality of life?
What are the 5 dimensions of it?
How are the questions ranked
Euro-QoL EQ-5D - mobility - self care - usual activities - pain/discomfort - anxiety/depression Ranked 1-3 e.g. 1. i have no problems walking about 2. i have some problems walking about 3. i am confined to bed
What are the advantages of using QALYs?
- takes into account impact on quality and quantity of life
- common unit of measure that can be used across disease areas
- convenient tools for measurement e.g. EQ-5D
How is QALYs gained calculated
QALYs with treatment - QALYs without treatment
So are we measuring utility?
QALYs used in cost utility analysis but economic definition of utility is ‘level of satisfaction from goods or services’
- utility in cost-utility analysis is purely about maximisation of health
- this is therefore not an economic definition
What are the concerns about QALYs?
- all QUALYs are valued the same
- insensitivity of questionnaires
- end of life treatments e.g. a good 6 months extra
- discrimination
- broader patient benefits
- ## family/carer benefits
What patient benefits are not captured by QALYs?
- control/empowerment
- reassurance
- knowledge
- satisfaction with caer
- capability
- family/carer QoL
What are the direct and indirect costs of an intervention?
Direct cost
- health and social services resource use e.g. inpatient, outpatient, tests, drugs
indirect cost
- non-health services resource use e.g. patient transportation, informal care
Indirect cost
- wider cost implications to society e.g. lost production
