Phase 3B Flashcards
What is opportunity cost?
To spend resources on one activity means sacrifice in opportunities elsewhere (e.g. money for heart transplant reduces money for hip replacements).
What is economic efficiency?
Resources are allocated between activities to maximise benefit.
What is economic equity
What is fair and just.
What is equity-efficiency trade off?
Improving equity may lead to loss of efficiency.
What is economic evaluation
Assessment of efficiency of activities (comparative study usually).
Ways to measure health benefits?
Natural units e.g. pain score.
Quality adjusted life years
Monetary value
What is a quality adjusted life year?
Length in years X quality.
e.g. 1 QALY = 1 year of perfect health.
4 ways for economic evaluation
Cost-effectiveness - outcome is natural unit e.g. pain score.
Cost-utility - outcome measured in quality adjusted life years.
Cost-benefit - outcome measured in monetary units.
Cost-minimisation - minimise cost measurement.
What is incremental analysis
Everything is relative so there must always be a comparison e.g. New imaging technique V old technique.
3 domains of PH
Improving services
Health protection
Health improvement
What can you do to enforce a health intervention, describe it…
- Health needs assessment = systematic method for reviewing health issues facing a population. Leads to agreed priorities for resource allocation and hopefully reduce inequality and improve health.
- Cycle of needs assessment –> planning –> implementation —> evaluation –> back to assessment.
- Epidemiological, comparative, corporate.
Calculation for point prevalence
Number of cases in population / population number
How to compare incidence?
Looks at relative risk. Ratio of incidence in the 2 groups of people.
Calculation = risk of non-smokers / risk of smokers.
If it is >1 = risk factor.
Odds ratio
Ratio of odds of a disease around exposed group and the odds of the disease among the unexposed group.
Number needed to treat
1/ Attributable risk.
Attributable risk = risk in smokers / risk in non-smokers X 100.
Calculation and definition of:
- Specificity?
- Sensitivity?
- PPV?
- NPV?
- number of true negatives / all those in actually don’t have disease. (TN/(FP+TN))
- number of true positives / everyone who actually has disease. (TP/ (TP+FN))
- = TP / (TP + FP)
- = TN / (FN + TN)
What can associated be due to?
Bias - publication, information, selection. Chance Confounding Reverse causality True association
Lead and length time bias
Lead time = early identification doesn’t alter outcome but improves survival.
Length time = Disease progress more slowly so unlikely to be picked up as asymptomatic but if they are screened for it appears screening prolongs life.
4 needs
Felt (individuals perception of variation of health from norm)
Expressed (individual seeks to remedy variation)
Normative (professionally defined intervention for expressed need)
Comparative (comparison in severity, cost)
Models for funding healthcare
Publicly - taxation, free to patients, e.g. UK.
Social insurance - compulsory sickness funds, e.g. France.
Privately funded - providers are private companies, e.g. USA.
How to measure burden of disease?
Quality adjusted life years = sum of years spent in health state / utility score of quality.
Disability-adjusted life years = sum of years of life lost from premature mortality / years lived in disability.
What is a cohort trial and what are some pros and cons
Data is obtained after the population have already been exposed to variables.
Pros: no allocation needed, ethically safe, can look at timings of exposure too.
Cons: confounders, unable to blind.
Crossover trial
Group 1 takes medicine for 1 week, then 2nd week has alternative intervention.
Group 2 takes alternative intervention for 1 week, then 2nd week takes medicine.
