measures of outcomes and costs in economic analysis

Question 1

what are the different types of measures for clinical outcomes and examples of each?

Answer 1

• Proxy outcomes e.g. cancers detected, change in cholesterol level
• Condition-specific measures e.g. Roland Morris questionnaire for back pain or CAT (COPD assessment test)
• Generic measures e.g. life years gained

Question 2

what are the advantages and disadvantages of using clinical outcomes to analyse effectiveness of different interventions?

Answer 2

advantages:

• easy to understand for clinicians/decision makers
• often measured as part of a clinical study

disadvantages:

• doesn’t let you measure more than one outcome together
• lack of comparability across different disease areas
• the outcomes are very specific so need to think about what each outcome means in terms of patient benefit and healthcare

Question 3

for QALYs, what scale is used to measure quality of life?

Answer 3

1 = perfect health (max value)
0 = dead

Question 4

what is the formula for measuring QALYs?

Answer 4

the SUM OF (length of life x quality of life)

Question 5

where can we get information from to measure quality of life?

Answer 5

• value judgement
• questionnaire
• direct measures from health state description
• published values in literature

Question 6

What is EQ-5D?

Answer 6

the Euro-QoL 5 dimensions questionnaire used to measure quality of life. the five dimensions are:

• Self care
• Pain/discomfort
• Anxiety
• Mobility
• Usual activities

(can remember as SPAMU :P)

Question 7

what are the advantages of using QALYs?

Answer 7

• takes into account quality AND quantity of life
• common units the can be used across disease areas
• convenient tools for measurement e.g. EQ-5D

Question 8

What are the drawbacks of using QALYs?

Answer 8

• ‘a QALY is a QALY is a QALY’ i.e. QALYs may differ in value in different peoples’ eyes yet they are all treated the same
• who sets the values for QALYs? clinicians? patients? public?
• should QALYs at end of life be valued higher?
• there may be discrimination over whose life is valued more due to QALYs
• not all of patient benefits can be measured by QALYs e.g. satisfaction with care, knowledge, control/empowerment, reassurance, capability
• QALYs can have an impact on patient family too, should this be taken into account?

Question 9

what is the difference between direct and indirect costs of an intervention?

Answer 9

direct cost = what specifically the money is being used for e.g. health service resources

indirect cost = the wider implications of spending the money in a certain way to society e.g. lost production

Question 10

give examples of primary care costs, secondary care costs and social services costs.

Answer 10

primary care costs - GP and practice nurse visits
secondary care costs - hospital outpatient visits, inpatient stays, surgery, A+E attendance, tests and investigations
social services costs - nursing home care, home help, home adaptations

Question 11

what are some of the possible indirect costs to patient healthcare?

Answer 11

• patient unable to work due to death or disability
• time off work due to illness
• reduced productivity

Question 12

what are some of the costs to the patient for getting healthcare?

Answer 12

• cost of over-the-counter medications
• cost of time and transport for healthcare visits
• private healthcare
• paid carers
• informal carer time e.g. relative