PH Flashcards
4 types economic evaluation
Cost-effectiveness analysis (CEA)
Cost-utility analysis
Cost-benefit analysis:
Cost-minimisation analysis
Cost-effectiveness analysis
Outcomes are measured in natural units (e.g. incremental cost per life year gained)
Cost-utility analysis
Outcomes are measured in quality adjusted life years (e.g. incremental cost per QALY gained)
Cost-benefit analysis:
Outcomes are measured in monetary units (e.g. net monetary benefit)
Cost-minimisation analysis:
Outcomes (measured in any units) are the same in both treatments. This is used when the aim is only to minimise costs.
incremental cost-effectiveness ratio (ICER)
cost-effectiveness can be summarised in terms of an incremental cost-effectiveness ratio (ICER)
he incremental costs of one treatment over another, divided by the incremental effects. So, if a new treatment produces 10 additional years of life more than current treatments and costs £10,000 more than current treatments, its ICER is 10,000 divided by 10, or £1,000 per life year gained.
The ICER, therefore, combines cost and outcome data in a simple summary measure. Treatments with lower ICERs produce units of health (e.g. life years) at lower cost than treatments with higher ICERs. As such, they are said to be more cost-effective
calculate QALYs
multiply the length of life expected to be gained by the new treatment or invention, by the quality of life a patient can expect to have.
how is quality of life measured?
on a 0 - 1 scale and this score represents the value of different levels of health. We’ll be exploring what these numbers mean and where they come from later on in this course.
We can think of a single QALY as being equivalent to one year in perfect health.
How do we find the ‘Q’ in QALYs
There are a number of elements required in order to do this:
We need to describe the health state that is going to be valued.- usually done using PROMs e.g. EQ 5D DL
We need a way to value the health state that we have described.
We need a group of people to provide the values.
A patient lives in a health state with a quality of life of 0.4 for 2 years, followed by a health state with a quality of life of 0.2 for 5 years, how many QALYs is this?
1.8
opportunity cost
The health benefits for patients that will be foregone if a new treatment is funded
obesogenic environemnt
physical: car culture
economic: expesive fruit and veg
sociocultural: family eating patterns
the runaway wt gain train
obesogenic environment=steep slope
knowledge, prejudice, phsyiology=ineffective brakes
vicious cycles mechanical dyfunct, psychological impact, ineffective deiting, low socioeconomic status=accelerators
mechanisms that maintain being overwt
physical: more wt=more difficult to exercie and dieting (metabolic response)
psychological: low self esteem, guilt, comfort eating
socioeconomic: rediced opportunities, employmeny, relationships, social mobility
epigenetics
The expression of a genome depends on the environment
allostasis
same as homeostasis
The stability through change of our physiological systems to adapt rapidly to change in environment
allostatic load
Long-term overtaxation of our physiological systems leading to impaired health (stress)
salutogenesis
Favourable physiological changes secondary to experiences which promote healing and health
role or primary care
Managing illness and clinical relationships over time
Finding the best available clinical solutions to clinical problems
Preventing illness
Promoting health
Managing clinical uncertainty
Getting the best outcomes with available resources
Working in the primary health care team
Shared decision making with patients
dangers of over prescribing abx
Unnecessary side effects
Medicalisation of self-limiting conditions
Antibiotic resistance
centor criteria
Tonsillar exudate
Absence of cough
Tender or large cervical lymphadenopathy
Fever
public health
the science and art of preventing disease, prolonging life and promoting health through organised efforts of society
3 domains of public health
Health improvement
Health protection
Improving services
key concerns of public health
Inequalities in health
Wider determinants of health
Prevention