Quality of life Flashcards by Saskia Chapman

what must be prioritised

interventions with a high health gain per £ spent must be prioritised

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NICE

in charge of deciding which treatments are cost effective.

- does not price or pay for technologies

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what do NICE use

cost effectiveness analysis (CEA)

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CEA

cost effective analsysis

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what will NHS commissioning bodies not fund

technologies perceived as poor value

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HTA

health technology assessmet

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where HTA fits in

CEA is the COMPARATIVE analysis of alternative courses of action in terms of both cost and consequence of health

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NICE compares

different treatments and compares COST and health outcomes

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QALY

a currency for health

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QALYs measure

overall heath/ effecitveness

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two variables QALYs take into consideration

length of life

- quality of life

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dead

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full health

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QALY equation

life expectancy X Health related quality of life

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2 years in full quality of life=

2 x 1.0 = 2 QALY

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2 years in 50% quality of life=

2 x 0.5 = 1 QALY

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what is HTA concerned with when it comes to QALYs

the number accumulated

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on a graph QALY

time is dependent, HR-QoL is independent

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the better treatment

will have a less steep gradient i.e. longer life expectancy and better QofL

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QALYs gained

area under the graph

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if the lines of the two treatments cross

one treatment may give better QoL, but worse life expectancy

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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

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