Phase 3B Health Economics Flashcards
QALY calculation
- Multiply the length of life (in years) expected to be gained by the new treatment or invention, by the quality of life a patient can expect to have.
- Quality of life is measured on a 0 - 1 scale
QALYs.
a) The ‘Q’ in QALY - examples
b) Why are QALYs useful?
a) PROMs - preference-based or utility measures
b) They provide a common unit of benefit that allows comparison both within and between clinical area
Two methods to measure the value patients put on health
Time trade-off.
- Asks individuals how much time they would be willing to give up in order to avoid poor health states
The standard gamble.
- Asks individuals how much risk they are willing to take in order to avoid poor health states
Time trade-off:
a) Explain the method
b) explain how a health state might be valued as 0.6 (scale 0 - 1)
a) A method of valuing health states that involves giving up or trading life years for a better quality of life or to avoid poor quality of life.
b) An individual would equate 6 years of full health to 10 years of health at this state (6/10 = 0.6)
Economic evaluation.
a) Define
a) A comparison of the costs and benefits of two or more (healthcare) interventions
An economic evaluation always involve a comparison of at least two alternatives and that the comparison is made with respect to both costs and benefits. If a study does not meet both these criteria, then it is not an economic evaluation
Quality healthcare is… (STEEEP)
Safe Timely Efficient Equitable Effective Patient-centred
Health economics evaluation of disability.
Disability-adjusted life years (DALYs)
0 = year of perfect health
(the higher the number, the worse the disability)
Equity and efficiency.
a) Define equity
b) Define efficiency
c) Explain the trade-off
a) Fair distribution of resources
b) Allocation of resources between activities in such a way as to maximise benefit
c) Improving equity often leads to a loss in
efficiency (eg. funding more for expensive diseases that lead to fewer resources to spend elsewhere)
Opportunity cost.
- To spend resources on one activity (eg. heart transplants) means a sacrifice in terms of a lost opportunity cost elsewhere
- The opportunity cost of an activity is the sacrifice in
terms of the benefits forgone from not allocating
resources to next best activity
Effect of disease prevalence on:
- Sensitivity and specificity
- PPV and NPV
- Sensitivity and specificity are fixed (Unaffected by prevalence)
- PPV increases with prevalence; NPV decreases with prevalence
Note:
- Sensitivity and specificity are what doctors care about, as they are a measure of how good a test is (at detecting patients with disease/excluding those without)
- PPV and NPV are what PATIENTS care about (“If I get a positive result, what is the chance I have the disease”, and vice-versa)
Healthcare systems
Publicly-funded systems (eg. NHS)
- funded through taxation, publicly-owned services
Social insurance funded health systems (eg. Singapore, Germany)
- compulsory sickness funds for healthcare; separate providers contracted to provide services which are paid for by fund
Privately funded systems (eg. USA)
Types of economic evaluation
- Give the 4 types and their outcome measures
Cost-effectiveness analysis.
- outcome: incremental cost per life year gained
Cost-utility analysis.
- utility outcomes (QALYs, DALYs)
- eg. incremental cost per QALY gained
Cost-benefit analysis
- uses monetary outcomes
Cost-minimisation analysis
- outcomes known to be equal, just comparing costs (which is cheaper?)
Incremental cost-effectiveness ratio (ICER).
a) How to calculate
b) Units (in cost-effectiveness vs. cost utility analyses)
c) Funding thresholds for NICE
d) “Existing drug costs £10,000 and adds 5 QALYs; new drug costs £15,000 and adds 6 QALYs”
- What is the ICER?
e) Problems with ICER rule
(Cost of intervention A minus Cost of intervention B, in £) divided by (Benefit of A minus Benefit of B, in QALYs)
b) Cost (£) per life-year (CEA) or QALY (CUA) gained
c) NICE define threshold of ~ £20,000 per QALY gained
(if more expensive than this per QALY gained, it will likely not be funded)
d) (15,000 - 10,000) / (6 - 5)
= £5,000 per QALY gained
e) - Palliative treatments may not be funded due to lack of survival added
- Very rare diseases with expensive treatments will not be funded
- Patient choice not factored in; individual funding requests
ICER planes:
a) Dominant treatments
b) Dominated treatments
c) Other 2 options
a) Dominant interventions.
- Less costly (-ve incremental cost), and
- More effective (+ve incremental QALYs)
(should be funded)
b) Dominated interventions.
- More costly (+ve incremental cost, and
- Less effective (-ve incremental QALYs)
(should not be funded)
c) - More effective, but more effective
- Less costly, but less effective
(may or may not be funded)
