Quality of life and health economics Flashcards
who are in charge of deciding which drugs are approved for use in the UK
NICE
NICE uses
HTA
HTA
health technology assessments
HTA use
cost effective analysis
CEA is concerned with
ratio of cost to health effect
CEA is the comparative
analysis of alternative course of actions terms cost and consequence for health
CEA looks at
treatment A and B and compares their cost and health outcomes
e.g. if Drug A is cheaper and more effective than Drug B then Drug A is the better value
health technology assessment is interested
accumulation of QALYs over time
QALY
is measure of overall effectiveness in terms of life and quality of life (0-1)
QALYs =
life expectancy (life years) x HR-Qol (utility)
2 years in full quality of life would mean
2 QALYs
2 years in 50% quality of life
2x 0.5= 1
quality of life is measured between
0-1
the more QALYs
the better
QALY is a generic measure of
disease burden- including both the quality of life lived and quanitity
how are QALYs used
used in economic evaluation to assess the value for money of medical interventions
1 QALY equates to
one year of perfect health
3 different methods of calculating HR-QoL
- EQ:5D
- TTO
- standard gamble
- visual analogues
on a graph of HR-QoL and time..
the area under the graph is the number of QALYs gained
EQ:5D
a questionnaire used to measure HR-QoL
what are the 5 EQ:5D
1) mobility
2) self-care
3) depression and anxiety
4) usual activities
5) pain/discomfort
these 5 EQ:5D are rated out of
3, then these are ordered into a 5 digit number e.g. 1,2,1,3,1 and a computer calculates score
NICE prefers
EQ:5D as a measure of HR-QoL
standard gamble
(think of drawings)
the worst the health state, the higher the risk of immediate death one will accept in order to avoid it
- involves weighing trade-offs
- measures the preference of individuals under risk situations
why is standard gamble sometimes preferred
since in real life, patient swill need to make risky decisions
visual analogues
another way of measuring HR-QoL
- gives you a scale and asks how you feel on that day regarding your disease
- simple and quick
Time trade offs
(think of drawing) basically say how much shorter would you cut your life to be living in full health again, at least for a while.
-evaluates the desirability of living the remainder of ones life in the current state of health or shorter life in excellent heath
what is used to measure cost-effectiveness ratio
ICER
ICER stands for
incremental cost effectiveness ratio
ICER involves calculated
QALYs
equation for ICER
difference in cost/ difference in QALYs
ICER- cost and QALYs
costs and QALYs of the CURRENT technology are always subtracted form the new technology
what is the current treatment always subtracted from the new technology
expected that health gain will be achieved with the new technology
when thinking about strategies we must think of
hospital care cost
- emergency treatment cost
- end of life palliation
models must include
long term consequential costs as well as obvious up front costs of buying the treatment
If patient succumbs to the disease
NHS cost is zero
what is the threshold of £/ QALY gained
£20,000
however up to £ / QALY gained e.g. at end of life
£30,000
