Session 8.1 - Healthcare ecnomics

Question 1

What is healthcare economics?

Answer 1

-Assumes resources are scarce and seeks to provide information to assist in the allocation of resources in an efficient and equitable way

Question 2

What is opportunity cost?

Answer 2

-Once you have used a resource in one way it is no longer available to use in a different way. The opportunity cost of a tx is the value of the next best alternative use of those resources

Question 3

when measuring the cost of a treatment, what factors are taken into account?

Answer 3

• Identify, quantity and value of resource needed
• Cost of healthcare
• Cost of patient time
• Cost of care-giving
• Economic cost by employers

Question 4

What factors are taken into account when measuring the benefit of a treatment?

Answer 4

• Impact on health status
• Savings in healthcare resources
• Improved productivity of patient

Question 5

What is cost minimisation analysis?

Answer 5

• Outcomes assumed to be equivalent regardless of tx chosen

- Focusses on inputs of resources only ie chooses the cheapest option

Question 6

What is cost effectiveness analysis?

Answer 6

• Getting most for your money
• Compares interventions with common health outcomes eg lowering bp
• compared in cost per unit outcome eg cost/5mmHG lowered
• Is the extra benefit worth the extra cost?

Question 7

What is cost benefit analysis?

Answer 7

• Compares everything in money by placing a price on how much it means to the patient
• Compares outputs and inputs
• Willingness to pay

Question 8

What is the major difficulty of cost benefit analysis?

Answer 8

-Difficult to put a monetary value on non-monetary benefits eg saving lives

Question 9

What is cost utility analysis?

Answer 9

• A type of cost effectiveness analysis
• Focusses on the quality of health produced/benefits foregone
• Measured in QALY = 1 perfect year of health or 10 years at 0.1 health or 6months of 1 health for 2 people

Question 10

What is the advantage of using cost utility analysis?

Answer 10

-Using QALYs allows comparisons to be made across different programmes

Question 11

How is quality of life assessed for QALYs?

Answer 11

-Using questionnaires such as EQ-5D

Question 12

How is cost utility calculated?

Answer 12

• Cost per QALY gained
• Work out QALY for each treatment
• Work out QALYs gained
• Work out how much it costs per QALY gained from total cost of treatment divided by QALYs gained

Question 13

Give 3 alternatives to QALYs

Answer 13

• Health Year Equivalents (HYE)
• Saved-Young-Livefe Equivalents (SAVEs)
• Disability Adjusted Life Years (DALYs)

Question 14

How does NICE use QALYs?

Answer 14

• QALYs integrated with price to determine cost effectiveness
• Below 20K per QALY accepted
• 20-30K/QALY judgement takes into account degree of uncertainty, if chalnge in HRQoL has been adequately captured by QALY, any benefits not captured by QALY
• Above 30K needs to be a very strong case

Question 15

Who is involved in NICE in decided the cost effectiveness of treatments?

Answer 15

-DoH, HCPs, patients, carers and public

Question 16

What are the concerns of using NICE to decide the acceptance/rejection of treatments?

Answer 16

• Political interference
• CCGs prioritise NICE-approved interventions with unintended consequences
• May be represented by pharmaceutical companies and/or patient groups

Question 17

Describe some criticisms of QALYs

Answer 17

• Controversy over values
• Doesn’t distribute resources according to need but benefits per unit cost
• Disadvantages common conditions-> not allocated a fair impact on health
• Dont assess impact on carers and family