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Pharmacoeconomics > Objectives > Flashcards

Objectives Flashcards

1
Q

Where are cohort and case-control studies in the hierarchy of evidence?

A 
Best --> Worst
Meta-analysis
Systemic reviews
Critically appraised sources
RCTs
Cohort
Case control
Case reports
Expert opinion
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2
Q

What are the types of cohort studies?

A

Prospective (study starts at the exposure)
Retrospective (study starts after disease progression)
Ambidirectional (study starts at the beginning of the disease after exposure)

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3
Q

What are the types of cohorts?

A

Closed
Fixed
Open

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4
Q

What is a closed cohort?

A

Group followed from start tp pre-defined time end

People cannot enter or leave

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5
Q

What is a fixed cohort?

A

When follow-up time is same for all group members

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6
Q

What is an open cohort?

A

People can enter or leave cohort over chosen time-frame

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7
Q

What is cohort exposure?

A

Can vary based on levels/doses

Can also select non-exposed group separately, but must be as equivalent to exposed as possible

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8
Q

What are cohort outcomes?

A

ECHO

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9
Q

What does ECHO stand for?

A

Economic (Direct and indirect costs)
Clinical (A1c, asthma control, BP)
Humanistic outcomes (QoL, satisfaction w/care)

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10
Q

What is a case-control study?

A

Retrospective

Both cases and controls look back at the exposed and unexposed groups

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11
Q

In a case-control study, what results are we looking for?

A

Physical

Pathological

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12
Q

In a case-control study, why is accuracy important?

A

Do not want to include false positives

Be as restrictive as possible

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13
Q

In a case-control study, where does study information come from?

A 
Hospital records
Clinic patient rosters
Death certificates
Cancer registries
Birth registries
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14
Q

In a case-control study, what are the types of cases?

A

Incident cases

Prevalent cases

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15
Q

What are incident cases?

A

New cases

If interested in causes of disease

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16
Q

What are prevalent cases?

A

Old cases

If wanting to know about factors affecting duration

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17
Q

In a case-control study, what are controls?

A

Sample of population that produced cases (study base)

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18
Q

What is a good control?

A

Members of the controls would be a case if they developed the condition

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19
Q

What are sources of controls?

A

Population
Hospital/clinic
Friend/spouse/relative

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20
Q

What should the ratio of control to cases be?

A

1:1 - 1:4

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21
Q

What are the ways to analyze cohort studies?

A

Incidence rate
Risk ratio
Risk difference
Odds ratio

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22
Q

What is an incidence rate?

A

Rate of incidence in both exposed and unexposed groups

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23
Q

What is a risk ratio?

A

Ratio of incidence rates in both the exposed and unexposed groups (a/a+b)/(c/c+d)

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24
Q

What does a risk ratio of 1 mean?

A

No difference

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25
Q

What does a risk ratio > 1 mean?

A

Increased risk

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26
Q

What does a risk ratio of < 1 mean?

A

Decreased risk

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27
Q

What is risk difference?

A

Exposed minus the unexposed rates

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28
Q

What is an odds ratio?

A

Represents the odds that an outcome will occur given a particular exposure compared to the odds of the outcome occurring (a/b)/(c/d)

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29
Q

What is an experiment?

A

Series of observations made under conditions controlled by scientists

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30
Q

What is a randomized experiment?

A

Experiment in which units assigned to receive treatment by random process

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31
Q

What is an observational study?

A

Simply observes size and direction of relationship among variables

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32
Q

What is random sampling?

A

Makes a sample of subjects similar to a population

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33
Q

What is a random assignment?

A

Makes sample of subjects similar to each other

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34
Q

What are institutional review boards (IRBs)?

A

Required for institutions who experiment on humans

Reviews study protocol to ensure Belmont report adhered to

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35
Q

What is a type I error?

A

Finding association when there is not

False positive

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36
Q

What is a type II error?

A

Finding an association when there is

False negative

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37
Q

What is an alpha error?

A

Type I error
Same as p-value
Usually findings < 0.05 are significant

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38
Q

What is a beta error?

A

Type II error

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39
Q

How is power calculated?

A

1-beta

Usually set at 20% (80% power)

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40
Q

What is representative sampling?

A

Sample that looks like population

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41
Q

What are types of representative samples?

A

Random

Stratified random

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42
Q

What is random sampling?

A

Potential subjects have non-zero chance of being selected

Requires access to everyone in population

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43
Q

What is stratified random sampling?

A

Perform random sample of individuals based on a certain set of characteristics

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44
Q

What are non-representative sampling?

A

Most common type of sample, convenience sample

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45
Q

What are types of non-representative sampling?

A

Purposively sample:
Non-random
Only selects people with a defining characteristic

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46
Q

What are the types of observational studies?

A

Cross-sectional

Quasi-experimental

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47
Q

What is a cross-sectional study?

A

Gather info at 1 point in time (cross-section)
Descriptive
Can measure prevalence well
Associations b/n DV and IV

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48
Q

Which observational study can identify causal relationships?

A

Quasi-experimental

49
Q

What is a quasi-experimental study?

A

Treatment controlled by researcher

Subjects not randomly assigned to treatment

50
Q

Which observational study has high internal validity?

A

Quasi-experimental

51
Q

What do quasi-experimental studies need to infer causation?

A

More data than RCTs

More assumptions in analysis to infer causation

52
Q

What is bivariate analyses?

A

Measures association between 2 variables of interest

53
Q

What is multivariate analyses?

A

Measures association between a DV and IVs

54
Q

What is the most common type of statistical analyses?

A

Paramteric

55
Q

What are the most common types of parametric statistics?

A 
Mean
SD
Correlation
T-test
ANOVA
Linear regression
56
Q

What assumptions are made in parametric statistics?

A

Variable is quantitative
Linear relationship b/n DVs and IVs
Normality of error distribution

57
Q

What type of statistics has a DV that is normally distributed?

A

Parametric statistics

58
Q

What are types of non-parametric statistics?

A 
Chi-squared
Fisher's exact
Kruskal Wallis
Wilcoxon Mann Whitney
Spearman
Friedman
Logistic regression
59
Q

What is nominal data?

A

Used for labeling variables, without any quantitative data (nominal sounds like name)

60
Q

What are examples of nominal data?

A

Color
Sex
Location

61
Q

What is dichotomous data?

A

Data with only 2 categories
Yes/no
Male/female

62
Q

What is ordinal data?

A

The order of the data is important, but the difference between the values is not

63
Q

What are examples of ordinal data?

A

How do you feel? (Okay, happy, very happy)

64
Q

What is interval data?

A

Numeric scales in which we know the order and exact difference between the values

65
Q

What is an example of interval data?

A

Temperature

66
Q

What is ratio data?

A

Tells us about the order, the exact value between units, AND has an absolute zero

67
Q

What are examples of ratio data?

A

Ht

Wt

68
Q

What are the 3 pieces of cost determinants?

A

Identification
Measurement
Valuation

69
Q

What are types of hospital costing?

A

Micro-costing
Case-mix group (accounts for LOS)
Disease specific per diem (daily cost)
Per diem (mean daily cost for all patients)

70
Q

What is the most precise type of hospital costing?

A

Micro-costing

71
Q

What is the least precise type of hospital costing?

A

Per diem

72
Q

What are the tangible costs of pharmacoeconomic analyses?

A

Direct medical costs
Direct non-medical costs
Indirect costs

73
Q

What are direct medical costs and benefits?

A 
Medications
Medication monitoring
Medication administration
Patient counseling and consultations
Diagnostic tests
Hospitalizations
Clinic visits
ED visits
Home medical visits
Ambulance services
Nursing services
74
Q

What are direct non-medical costs?

A

Travel costs to receive health care
Nonmedical assistance related to condition
Hotel stays for patient or family for out-of-town care
Child care services for children of patients

75
Q

What are indirect costs and benefits?

A

Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity because of premature mortality

76
Q

What are intangible costs and benefits?

A

Unquantifiable costs and benefits
Improved health after treatment
Reduced pain
Pain and suffering associated with treatment

77
Q

What are short-term tracking of costs and outcomes?

A

Hospital to d/c

78
Q

What are medium-term tracking of costs and outcomes?

A

Payer

1-5 years

79
Q

What are long-term tracking of costs and outcomes?

A

Patients

Life-time

80
Q

What are the outcomes of CMA?

A

Assumed to be equivalent

81
Q

What are the outcomes of CEA?

A

Natural units (life years saved)

82
Q

What are the outcomes of CBA?

A

$

83
Q

What are the outcomes of CUA?

A

QALY

84
Q

What are the questions answered by CBA?

A

Which programs should be implemented

How much or what combination of outputs should be produced

85
Q

What are the methods of measuring CBA?

A

Human capital

Willingness to pay

86
Q

What is the simplest evaluation?

A

CMA

87
Q

How is CMA used?

A

Compares 2+ alternative treatments that produce equivalent outcomes
Choose option with lowest cost

88
Q

What is net benefit?

A

Total benefit - total costs

89
Q

What benefit:cost ratio is preferred?

A

> 1

90
Q

What does ICER stand for?

A

Incremental cost-effectiveness ratio

91
Q

When are interventions said to be cost effective?

A

Less expensive AND more effective
Less expensive AND at least as effective
More expensive AND more effective

92
Q

When is an ICER positive?

A

New tx more expensive AND more effective
New tx less costly AND less effective
Want smaller ICER

93
Q

When is an ICER negative?

A

New tx less costly AND more effective

New tx more costly AND less effective

94
Q

When is an ICER dominant?

A

Less costly AND more effective

95
Q

When is an ICER dominated?

A

More costly AND less effective

96
Q

What is a type of CEA?

A

CUA

97
Q

What is QALY?

A

Combination of quantity life gained (mortality)
AND
Quality of the life gained (morbidity)

98
Q

How do we measure quality of life gained?

A

Scale from 0 (death) - 1 (perfect health)

99
Q

What are the disadvantages of a CUA?

A

Most difficult
Most time consuming
Most expensive

100
Q

What are the ways to estimate utilities?

A

Visual analog scale (VAS)
Standard gamble (SG)
Time Trade-Off (TTO)

101
Q

What is the VAS?

A

Easiest method to directly obtain utilities

102
Q

What is a standard gamble?

A

Based on utility theory

2 alternatives

103
Q

What is TTO?

A

Simpler, easier to use then SG

Subject offered 2 alternatives and they get to choose

104
Q

What is a latent variable?

A

An unobservable phenomenon that takes on a specific value under a set of conditions

105
Q

What are examples of latent variables?

A

Trust in physicians
QoL
Health literacy levels

106
Q

What is reliability?

A

Proportion of variance attributable to the true score of the latent variable

107
Q

What is a true score?

A

A scale developed to measure a latent variable is intended to estimate its actual magnitude at the time and place of measurement for each subject

108
Q

What does reliability measure?

A

Same result

109
Q

What are the types of validity?

A

Content validity
Criterion-related validity
Construct validity

110
Q

What question does validity answer?

A

Is the latent variable the underlying cause of item covariation

111
Q

What is content validity?

A

Extent to which a set of items reflects content domain

112
Q

When does a scale have content validity?

A

When items are a randomly chosen subset of the universe of appropriate items

113
Q

What is criterion-related validity?

A

Scale related to a gold standard

Also called predictive validity

114
Q

What does construct validity measure?

A

Measures theoretical relationship of a variable to other variables

115
Q

What are the two ways to measure self-reported HRQoL?

A

Generic

Disease specific

116
Q

What are advantages of generic HRQoL?

A

Broadly applicable
Summarizes a range of concepts
May detect unanticipated effects

117
Q

What are disadvantages of generic HRQoL?

A

May not be responsive to changes in health
May not be relevant for specific populations
Results may be difficult to interpret

118
Q

What are advantages of disease specific HRQoL?

A

More relevant for specific populations

More responsive to changes in health

119
Q

What are disadvantages of disease specific HRQoL?

A

Cannot compare across populations

Less likely to detect unanticipated effects

Pharmacoeconomics (5 decks)

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