Session 9 - Resource Allocation and Patient Reported Outcomes

Question 1

State and explain the 2 types of rationing

Answer 1

Implicit rationing:
- The allocation of resources through individual clinical decisions WITHOUT the criteria for the decisions being explicit

Explicit rationing:
- Use of institutional procedures for the systematic allocation of resources within the health care system

Question 2

Explain the negatives for each type of rationing

Answer 2

Implicit rationing:

• Open to abuse
• Can lead to discrimination or inequality
• Decisions based on perceptions of social deservedness

Explicit rationing:

• Very complex e.g. assessments required for efficiency and equity
• Impacts clinical judgement/freedom
• Heterogeneity of patients and illness (one size doesn’t fit all!)

Question 3

Explain how opportunity cost is measured

Answer 3

Opportunity cost is measured by the benefits foregone (seen as sacrifice rather than financial expenditure)

Question 4

Explain technical efficiency and allocative efficiency

Answer 4

Technical efficiency:
- Interested in the most efficient way of meeting a need e.g. hospital or community based

Allocative efficiency:
- Choice between the many needs to be met i.e. where to allocate the care e.g. hip replacement or neonatal care

Question 5

List the 4 types of economic evaluation and briefly explain the method of each

Answer 5

1. Cost minimisation analysis
   - Only focused on cost (not output/benefit etc.)
2. Cost effectiveness analysis
   - Used to compare drugs/treatments with a common health outcome i.e. is extra benefit worth the extra cost?
3. Cost benefit analysis
   - All inputs and outputs are valued in monetary terms (reflects how much are you willing to pay analogy)
4. Cost utility analysis
   - A specific type of cost effectiveness analysis which focuses on quality of health outcomes that are produced or foregone
   - Uses QALY (quality adjusted life years)

Question 6

Explain how QALY is calculated and what it takes into account

Answer 6

1 QALY is 1 year of perfect health

QALY takes into account quality of live and quantity of life

Question 7

List 3 criticisms of QALYs

Answer 7

1. Don’t assess impact on carers or family
2. May disadvantage common conditions
3. Based on lots of assumptions - so technical problems with the calculations

Question 8

State the meaning of patient reported outcomes (PROs)

Answer 8

Patient reported outcomes is the status of a patient’s health condition reported directly from the patient, without interpretation from a clinician

Question 9

Explain the meaning of patient reported outcome measures (PROMs)

Answer 9

Patient reported outcome measures are tools or instruments used to measure patient reported outcomes - allows for the conversion of subjective experiences into numerical values

Question 10

Define quality of life (QoL)

Answer 10

Multidimensional concept that includes domains related to physical, mental, emotional and social functioning

Question 11

Define health-related quality of life (HRQoL) and give 3 samples of quality of life that are routinely measured

Answer 11

Functional effect of an illness and its consequent therapy on a patient, as perceived by the patient

1. Psychological well being
2. Physical dysfunction
3. Cognitive functioning

Question 12

List the 2 important properties of PROMs and briefly explain what they mean

Answer 12

1. Reliability - is the instrument accurate over time and consistent?
2. Validity - does the instrument measure what it’s supposed to measure?

Question 13

State the 2 types of PROMs

Answer 13

1. Generic

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2. Specific
subsections
- Disease specific
- Site specific
- Dimension specific
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Question 14

List the 5 dimensions of EQ-5D and the 3 different levels for each dimension

Answer 14

1. Mobility
2. Self-care
3. Usual activities
4. Pain/discomfort
5. Anxiety/depression

3 levels:

1. No problems
2. Some/moderate problems
3. Extreme problems

Question 15

List 2 advantages and disadvantages of generic instruments and same for specific instruments

Answer 15

Generic instruments:
Advantages:
- Enables comparison across condition and treatment groups
- Can be used for a range of health problems
Disadvantages:
- Generic nature means they are less detailed
- Less acceptable to patients (less relevant to them)

Specific instruments:
Advantages:
- Content is very detailed and relevant 
- Sensitive to change
Disadvantages:
- Comparison is limited
- Might not detect unexpected outcomes