Pharmacoeconomic Analysis Flashcards
1
Q
How are health care resources allocated (past and present)
A
- In the past is was all based on expert opinion, historical practices and intuition
- This results in an increasing cost which consumes GDP
2. Now a more evidence based approach happens - Economic analysis: compares between the courses of action based on costs (inputs) and benefits (outcomes)
- Pharmacoeconomic analysis (PEA): economic analysis that considers alternative drug therapies which are compared to non drug therapies which Is based on costs (inputs) and benefits (outcomes)
- This results in an increasing cost which consumes GDP
2
Q
PEA inputs and outcomes
A
- Inputs: generally expressed in monetary terms
- Health care sector (direct/ medical)
- Patient/ family (direct/ nonmedical)
- Other sectors (direct/ nonmedical)
- Productivity: indirect
2. Outcomes can be measured in terms of money (return on investment) , health state or utility (utility is changed and perceived value to the individual)
3
Q
PEA inputs (3)
A
a) Medical
- The monetary value of healthcare resources
- Associated with prevention, detection or treatment of disease or illness
- Some examples are hospital stays, drugs…
b) Non medical
- Monetary value of non healthcare resources
- Associated with prevention, detection or treatment of disease or illness
- Examples are child care expenses, lost wages, social services
2. Indirect costs
- Lost productivity associated with morbidity
- Dollar amount based on earning capacity using actual or assigned wages
3. Intangible costs
- The cost of the disease and illness that cant be expressed in monetary terms
- Pain, suffering…
4
Q
PEA outcomes/ The ECHO model
A
- Economic outcomes (payer centred)
- Direct, indirect and intangible value expressed as an outcome
2. Clinical outcomes (provider centred) - Changes in morbidity, mortality and biological markers
- Final: changes in levels or rates or morbidity/ mortality
- Intermediate: the time constraints difficult to measure final clinical outcomes so make a link with a clinical trial
- A proxy for much more relevant final outcomes
- In order to be useful they must be reliable predictors of the final outcomes
3. Humanistic outcomes (patient centred) - Functional status
- Utility
- Focused on disease specific signs and symptoms
- Usually fail to recognize the patients social aspects of their disease
- Starting to gain a larger role and looking at how the intervention effects the patients quality of life
- Direct, indirect and intangible value expressed as an outcome
5
Q
What is quality of life
A
- Encompasses the entire range of human experience, perceptions and states of being
- Health related quality of life
- The aspects of life that are effected by personal health
a) HRQL Is looked at by many different dimensions
- Physical
- Mental
- Social interaction
- Energy
- Level of pain
b) An example is the EQ-5D
- A European quality of life test to access the patients HRQL
- Health related quality of life
6
Q
Health utility
A
- Refers to the patients preference or perceived value for a health state
- 1.0 is perfect health
- 0.0 is death
- We understand that there some would say that there health is in a negative state compared to death but we don’t assess these
1. Methods for determining utility - Indirectly
- Show utility based on a test of functional status
- Eg. Health utilities index
2. Directly - Rating scales: ranking
- Standard gamble: risk based choice
- Time trade off: time based choice
7
Q
How to measure utility indirectly
A
- Health utilities index 3 (HUI3)
- Measures functional status based on 8 attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain)
- All of the attributes are single item scales
- Each is individually scored and then this score is assigned a predetermined utility
8
Q
How to measure utility directly
A
- More favoured by economists
- Rating scale
- You just rate your status on a scale 0-1 - Standard gamble
- probabilities of full health for the rest of your life vs immediate death
- Rating scale
- or live the rest of your life in your existing state of health
- Time trade off
- trading years of your life for full health
9
Q
Issues when measuring utility
A
- Utility and time: assumes people are the same to time spent in a health state
- Acute utility values often under-estimated: patients are okay to spend lots of money to avoid severe short term events
- Risk neutral vs risk adverse: assumes people can objectively weigh options
- Tend to overvalue a current situation due to strong feelings
- Major concern in standard gamble
10
Q
Types of pharmacoeconomic analysis
A
Partial vs complete
11
Q
Partial
A
either input or outcome
- Cost analysis
Benefit analysis
12
Q
Complete pharmacoeconomic analysis
A
- Cost- minimization analysis (CMA)
- Cost benefit analysis
- Cost utility analysis
13
Q
Limitations of CMA
A
- Identical outcomes/ benefits often seen with me too drugs but other then this identical values are uncommon
- The difference is often very small and not clinically significant
14
Q
Cost effectiveness analysis
A
- CEA
- Outcomes measured in natural units such as years of life saved, blood pressure, death rates
- Measure the same outcome but the amount or level of the outcome is different
- Can compare different types of drugs of therapies if outcome of the drug is the same
- Incremental cost effectiveness ratio (ICER)
- CE = (C1 - C0) / (E1 - E0) (c=cost, e=effectiveness, with new drugs with old therapy you don’t look at compared to a placebo but rather the current therapy
15
Q
Limitations of CEA
A
- Difficult to assess value of a clinical outcome (may live longer but the quality of life may not be better)
- Very difficult to use with multiple outcomes
