PASS S9 - Resource allocation and PROMs Flashcards
Impact of scarce resources on the work of doctors
Demand outstrips supply
Difficult decisions have to be made
Priorities have to be set: ETHICS
Name the two types of rationing
Explicit
Implicit
What is implicit rationing?
The allocation of resources through individual clinical decisions without the criteria for those decisions being explicit
Can lead to inequities and discrimination
What is explicit rationing?
The use of institutional procedures for the systematic allocation of resources within health care system
Advantages of explicit rationing
Opportunity for debate
Transparent, accountable
More clearly evidence-based
Disadvantages of explicit rationing
Very complex
Patient and professional hostility
Impact on clinical freedom
Some evidence of patient distress
What is NICE?
National Institute for Health and Care Excellence
Enable evidence of clinical and cost effectiveness to be integrated to inform a national judgement on the value of a treatment(s) relative to alternative uses of resources
What are the 6 basic concepts in health economics?
Scarcity Efficiency Equity Effectiveness Utility Opportunity cost
What is opportunity cost?
Once you have used a resource in one way, you no longer have it to use in another way
Measured in BENEFITS FOREGONE
What is technical efficiency?
You are interested in the most efficient way of meeting a need
eg. should antenatal care be community or hospital-based?
What is allocative efficiency?
You are choosing between the many needs to be met
eg. fund hip replacements or neonatal care?
What are the 4 types of economic evaluation?
Cost minimisation analysis
Cost effectiveness analysis
Cost benefit analysis
Cost utility analysis
Explain cost minimisation analysis
Outcomes assumed to be equivalent
Focus is on the cost
eg. all prostheses for hip replacement improve mobility equally - choose the cheapest one
(not often relevant as outcomes rarely equivalent)
Explain cost effectiveness analysis
Used to compare drugs or interventions which have a common health outcome
Compared in terms of cost per unit outcome
Is extra benefit worth extra cost?
Explain cost benefit analysis
All inputs and outputs valued in monetary terms
Can allow comparisons with interventions outside healthcare
Explain cost utility analysis
Focuses on quality of health outcomes produced or foregone
Type of cost effectiveness analysis
Most frequently measure is QALY
What are QALYs?
Quality adjusted life years
Composite of survival and quality of life
1 year of perfect health = 1 QALY
Quality of life + quantity of life = QALY
How is quality of life measured?
Generic HR-QoL instrument: the EQ-5D
Alternatives to QALYs
Health year equivalents
Saved-young-life equivalents
Disability adjusted life years
Name some criticisms of QALYs
Controversy about the values they embody
Do not distribute resources according to need, but according to the benefits gained per unit of cost
May disadvantage common conditions
Technical problems with their calculations
What are PROMs?
The tools or instruments used to measure PROs: turn subjective experiences into numerical scores that can easily be utilised
What is HRQoL?
The functional effect of an illness and its consequent therapy upon a patient, as perceived by a patient
Define reliability
Is the instrument accurate over time and internally consistent?
Define validity
Does the instrument actually measure what it is intended to measure?
What are the two types of PROMs?
Generic: can be used in any patient population
Specific: disease specific, site specific and dimension specific
Example of a generic PROM
EQ-5D
Advantages of generic instruments
Can be used for a range of health problems
Can be used if no disease-specific instrument
Enable comparisons across treatment and condition groups
Disadvantages of generic instruments
Inherently less detailed
Loss of relevance
Can be less sensitive to changes that occur as a result of an intervention
Example of specific PROMs
Asthma quality of life questionnaire
Oxford hip score
Beck depression inventory
Advantages of specific instruments
Very relevant content
Sensitive to change
Acceptable to patients
Disadvantages of specific instruments
Can’t use them with people who don’t have the disease
Comparison is limited
May not detect unexpected effects
