October 30th Flashcards
What is scarcity?
-GDP is split between many sectors -basic economic problem, the gap between limited (scarce) resources and theoretically limitless wants -how GDP is split depends on political, cultural, and social factors
What are real world considerations for health spending?
Canada -some people are publicly insured -motivation is to reduce needless government expenditures US -health maintenance organizations- private, for-profit businesses (in the US) -motivation is to spend carefully -do not want to pay for expensive treatments when a cheaper option is available at similar effectiveness
What are normal markets?
-normal markets settle to an efficient optimal balance -buyers and sellers are happy -no intervention or rules are required -large number of buyers and sellers -no one can set prices (competition) -products are homogenous
What is an imperfect market?
-universal health insurance -you don’t know if/when you will need health care -when they need health care, costs are high -social values and the right to health care
In terms of healthcare, what are the components to an imperfect market?
-buyer (patient): does not bear the cost of the health care, often don’t know the most appropriate treatment/care option -agent (physician): guides patient through the process, doesn’t bear the cost of health care -seller/producer: industry- drug company, technology producers, clinics/hospitals
What is health technology?
-any intervention that may be used to promote health, to prevent, to diagnose, or to treat disease or for rehabilitation or long term care -eg. vaccines, CT scanners, etc. -all of these have costs and health technology attempts to balance these costs
What is health technology assessment? What is the purpose?
-the systematic evaluation of the properties and effects of a health technology, addressing the direct and intended effects of this technology, as well as its indirect and unintended consequences, and aimed mainly at informing decision making regarding health technologies -to support/help decision makers by identifying technologies that will improve health outcomes and deliver value for every dollar invested
What are the components of health technology assessment?
-systematic reviews -economic evaluation -budget impact analysis -social, ethical, or implementation issues -dissemination of results
What do systematic literature reviews do?
-clinical data for the technology and its comparators -critical appraisal for RCTs and non RCTs -SLR of economic models for technology -critical appraisal of economic models -SLR of utility data -SLR of resource use and cost data
What are key issues in designing HEE?
-Goal: maximize health using limited health resources -Perspective: who is paying? -Comparator: what to compare? -Time horizon: how long for evaluation?
What is a cost minimization analysis?
-look at the cost in dollars but don’t measure the consequences of the two interventions -two interventions that are equivalent in outcomes/consequences -how valid is the equivalence assumption? -eg. choosing a generic drug versus brand name
What is a cost effectiveness analysis?
-looks at the cost in dollars and the natural units (objective outcome, eg. years of life gained, BP reduction, etc.) -determine which program or treatment accomplishes a given objective at the least cost -done in number of lives saved, disabilities avoided, or cases prevented/treated
What is a cost utility analysis?
-look at the cost in dollars and quality-adjusted life years
What is a cost benefit analysis?
-look at the cost in dollars the consequences in dollars
What is the piggyback approach?
- approach to a cost effectiveness analysis
- uses trials: prospective
- embed or later add economic questions
- collect data on cost of health care provision and quality of life as people are added to the trial
-problems: trial settings are atypical (people may not be representative of population- have greater interest in their health), inadequate follow up, inappropriate clinical alternatives (we are limited with what we can compare), inadequate sample size for economic analysis, protocol-driven costs and benefits (if we jump on someone else’s research, we are limited to their protocol), inappropriate range of endpoints, can’t use studies that have varying effectiveness criteria, no control over the data collected (similar to retrospective cohort study), no standard criteria for why paramedic may do treatment A better than lay person but they do treatment B just as well as each other
What is standard gamble?
- standard gamble: probability of cure is systematically varied until decision makers are indifferent between their current level of disability and a specific probability of cure; the probability level of cure at the point of indifference (indifferent between death and cure) is a reflection of the utility that the decision maker attaches to the cure
- if a treatment had a 90% chance of cure and 10% chance of death, utility score is 0.9
