Quality of life Flashcards
what must be prioritised
interventions with a high health gain per £ spent must be prioritised
NICE
in charge of deciding which treatments are cost effective.
- does not price or pay for technologies
what do NICE use
cost effectiveness analysis (CEA)
CEA
cost effective analsysis
what will NHS commissioning bodies not fund
technologies perceived as poor value
HTA
health technology assessmet
where HTA fits in
CEA is the COMPARATIVE analysis of alternative courses of action in terms of both cost and consequence of health
NICE compares
different treatments and compares COST and health outcomes
QALY
a currency for health
QALYs measure
overall heath/ effecitveness
two variables QALYs take into consideration
- length of life
- quality of life
0=
dead
1=
full health
QALY equation
life expectancy X Health related quality of life
2 years in full quality of life=
2 x 1.0 = 2 QALY
2 years in 50% quality of life=
2 x 0.5 = 1 QALY
what is HTA concerned with when it comes to QALYs
the number accumulated
on a graph QALY
time is dependent, HR-QoL is independent
the better treatment
will have a less steep gradient i.e. longer life expectancy and better QofL
QALYs gained
area under the graph
if the lines of the two treatments cross
one treatment may give better QoL, but worse life expectancy
utility are measured on a cardinal scale of 0-1
0=dead
1= full health
Limitation of QALY
- limits in terms of health benefits it can capture
- blindness towards equity concerns
- underling theoretical ssusmption
what is used to describe HR-QoL
EQ-SD questionaire
EQ-SD questionnaire
i a favoured but generic method.
Patients answer 5 questions, referring to 5 domains of health
-asks about their health on that day
EQ-SD and patients in trials
in a trial may be asked to do questionnaire at baseline and at find intervals after treatment.
different types of QoL questionals
VAS, TTO, SG
VAS
visual analysis scale
TTO
time trade off
SG
Standard gambe
Visual analysis sacle
patient asked to draw line on scale summarising current health
benefits of VAS
easy to use with high response rate
-choice-less assessment
Time trade off
evaluated the desirability of living the remainder of ones life in the current health state compared to less time in excellent health
- NICE preferred method
Standard gamble
involves weighing trade-offs. Measures the preference of individuals under risky situations. Sometimes preferred since patients are asked make decisions involving risk
the worst the health state…
the higher risk of immediate death in order to avoid it.
choice of treatment can be impacted by treatment strategy…
- cost of treatment and administering it
- cost of hospital care
- emergency treatment
- end of life palliation
when a patient dies…
NHS cost become zero- no more money spent
modes must include
long term consequential coast as well as obis up from costs of buying
interested in the
difference in cost between treatment
ICER
incremental cost effectiveness ratio
what is an ICER
a conventional statistic used to summarise the results of cost effectiveness studies- allows to compare strategies
ICER equation
ICER = diff in cost/ diff in QALY
worked example of ICER
average cost of treatment b- average cost with treatment a/ average QALY of b - average QALY of a
3000-20000/ 4- 2= £500 per QALY gained
why is cost and QALY of the current standard treatment always subtracted from the new treatment
usually new treatment are most cost effective and increase QoL more
if new treatment is found in the NE/ SW box of the ICER graph
there is a ‘trade off’ between cot effectiveness e.g. may cost more, but the drug may be more effective and vice versa
if new treatment is found in NW box
- more expensive
- less effective
- old treatment prefered
if new treatment is found in SE box
both less expensive and more effective than the control
up to how much money per QALY may be justifiable
30,000
when is 30,000 her quarry justified
- uncertainty surrounding ICER
- strong reason t suspect the HR-QoL has not captured changed
- innovative nature of technology
high level of uncertainty in models
reduces the confidence with which the NICE committee can come to a decision
when may a higher cost effectiveness threshold be given to technologies
when the technologies are being utilised for end of life care
what are the three criteria end of life patients must meet to be allowed a higher cost effectiveness threshold
1) life expectancy less than 2 years
2) survival gain of more than 3 months
3) indication for a small patient pop.
how the EQ-SD is used for CE
- Patients asked to answer 5 questions referring to 5 domains- 5 digit number generated e.g. 1,2,1,3,1-> used on a linear scoring system OR A Time Tradeoff (TTO)
Name four dimensions of the EQ-5D?
- Can you do daily activities
- Pain
- Depression and anxiety
- Mobility
- Self-care
