Value Based Medicine Flashcards
EBM Cycle (5 Steps)
Patient with problem Formulate in answerable question Search the evidence Critically appraise the evidence Recommendations
What is Value?
Value = Quality/Cost
Morbidity << Mortality << QoL >> Patient satisfaction Health status
Cost, benefit,effectiveness, utility
Value (about life)
Quality of Life or Length of Life, or Both
Interventions which do not provide any of the 2 should be ignored
How to measure Quality of Life?
Quality of life instruments
- Function-based instruments
- Preference-based instruments
Both measures are not always interchangeable
Patient-preference based utility analysis is better
What is Functional Utility Analysis?
- NYHA classification of cardiac function
- Stroke functional classification
- Arthritis functional classification
Objective
What is Patient-preference utility analysis?
- Standard gamble utility analysis
- Willingness to pay utility analysis
- Time trade-off utility analysis
Subjective
Why Time-Trade Utility Analysis Is The Best:?
It is applicable in all health states
Good to excellent reproducibility
Readily understood by the patients
Low burden of administration
Generally unaffected by age, sex, ethnicity, education, income
Good construct validity (it measures what actually should be measured)
What is QALY?
Quality-adjusted life years
Represents quality of life and length of life
By convention:
QALY = 0 means death
QALY = 1 means perfect health
Example:
A patient with utility value of 0.8 and live for 5 years has
0.8 x 5 = 4 QALYs
What are Purposes of Health Technology? (6)
Promotion Prevention Diagnosis Treatment Rehabilitation Long-term care
Who Should Do?
Institutionalized:
WHO, National, universities, hospitals
Non-institutionalized:
Unions, social movements
Patient organizations
Industrial:
Internal,
In cooperation with hospitals, universities
Areas that HTA address (4)
High volume
High Risk
High Cost
High Variability
What a case report telling us about (5)
- Unusual presentation
- Inconclusive result
- Grey areas in indications or treatment
- Management Challenges
- Near misses case management
Economic Health Care Analysis (5)
- Cost minimization Analysis
- Cost benefit analysis
- Cost Effectiveness Analysis
- Cost Utility Analysis
- Budget Impact Analysis
What is cost minimization analysis?
COMPARING 2 equally effective intervention –> which is less costly
Outcome: intervention
What is Cost benefit analysis?
measures money saved by an intervention for the money expended
Outcome: money saved
