Week 4, 8 and 10 - Health Economics Flashcards
Explain the economic burden of disease
Healthcare cost is ↑ due to living longer (past 60 years)
= experience more diseases / complications = expensive to treat
Elderly become more expensive due to issues like HF, cancer etc.
- prescription medicine frequency increases with age
People expect to receive treatment + healthcare professionals may give treatment out of fear of being sued
- Undiagnosed, untreated hypertension is a WORLD wide problem
- Burden of CVD is ↑
- CVD is a leading cause of death
- expensive due to healthcare cost, indirect cost from premature mortality, indirect costs from premature morbidity
What is the true cost of health and healthcare (esp. in hypertension)
- Diagnose patient and give them lifestyle advice + medication to reduce high BP (= primary prevention of strokes etc.)
- primary care / prevention; with nurse, doctor, pharmacist - If already had a CV event, give patient secondary prevention treatment (prevents another event from occurring)
- secondary care / prevention; with A&E, stroke unit - Due to CV event may have to take time off work, travel to get medication etc.
- travelling could be a barrier
- lifestyle changes e.g. going gym = expensive + costs are by patient not inc. in healthcare system
What is intangible cost
Is suffering associated with the disease
- can’t add monetary value to it
What are Indirect Costs
How society is affected + productivity is lost
- i.e. due to sickness your job loses out on a valuable worker = productivity declines
- may not be able to attend school due to sickness = education is missed
- if die pre-maturely = society has lost out
What are Direct Costs
Direct Medical Costs
- costs imposed on healthcare system due to hypertension and CVD
- e.g. primary care, in-patient stroke unit, MI, surgery, rehabilitation
- CAN be FIXED, SEMI-FIXED and VARIABLE costs
- Fixed = “fixed set up cost” = building hospital, “fixed running cost” = lights, water
- Variable = ↑ with more patients you have e.g. medication, food
- Semi-fixed = temp. employment (only employed when it gets busy)
Direct Non-medical Costs
- is patient out of pocket costs e.g. gym membership, childcare
Explain methodological approaches to measure outcome and cost-effectiveness analysis of alternative treatments
Ways to reduce cost
- reduce costly CV events e.g. stroke, heart attack
- early diagnosis via BP monitoring
- screen for hypertension
What is intangible cost
Is suffering associated with the disease
- can’t add monetary value to it
What are the 4 basic methods of economic evaluation
OVERALL: want drug with ↑ effect, ↑ QALY and ↓ cost
- Cost Effective Analysis (CEA)
- used when 2 methods / drugs have diff. effectiveness
- think about cost of drug + its effectiveness
- want drug to be in SE quadrant (increased effect + decreased cost) - Cost Utility Analysis (CUA)
- a type of CEA, using utility methods
- compare results of diff. diseases + there clinical outcomes
- outcome is reported as QALYs (= utility value) - Cost Benefit Analysis (CBA)
- uses willingness to pay / monetary - Cost Minimisation Analysis (CMA)
- used if 2 methods have the same outcome but want to know what is cheapest
What is Incremental Cost Effectiveness Ratio (ICER)
CEA: Diff. in cost (of both drugs) ÷ Diff. in outcome (of both drugs)
CUA: Diff. in cost (of both drug) ÷ Diff. in QALY (of both drugs
- lifetime QUALYs help workout how many life years your buying (e.g. if prevent stroke patients life expectancy isn’t reduced)
- ins similar drugs (similar outcome) QUALY diff. is low
EQUATION:
difference in costs (of all drugs) ÷ difference in outcome
when picking qhich drug tp use may ask “what is the cost required to gain one more QALY”
What is the cost-effectiveness plane
x axis = effect (decreased effect to increased effect)
y axis = cost (decreased cost up to increased cost)
Has 4 quandrants:
NE = increased cost and increased effect
NW = increased cost and decreased effect
SE = decreased cost and increased effect
SW = decreased cost and decreased effect
WANT a drug in SE quandrant
DO NOT WANT drug in NW quandrant
How does scarcity and choice influence decisions about health
Need to justify why money was spent on one option and not the other
- resources in healthcare are scarce (not unlimited) = need to choose how we use them + what we use
- make choices by thinking about benefits + opportunity costs
How does benefits and opportunity costs influence decisions
Pick the treatment / intervention that has the highest benefit
- do NOT want to choose treatment where the opportunity cost is higher than the benefit
Opportunity cost = the benefit we are not getting / miss out on
What are the 4 ways outcomes are measured
Outcomes refer to the effect on patients
- Clinical indicators
- QoL (quality of life)
- Utility (QALY)
- Willingness to pay
How does ‘clinical indicators’ measure outcomes
They are specific indicators for a disease
- e.g. hypertension check BP
- e.g. angina check symptoms i.e. severity, duration
- e.g. hyperlipidaemia check HDL, LDL and total cholesterol
Clinical indicators help identify disease + its severity and decide treatment plan
We do NOT measure side effects
How does ‘QoL’ measure outcomes
QoL - an subjective evaluation about an individuals life
- affected by physical health, psychological state, personal beliefs, relationships and their environment
- has many domains + sub-divisions (e.g. HRQoL)
2 Types of QoL Measure:
1. Disease specific
- designed to look at QoL for a specific disease
- ADV: can focus on domain considered most important for that disease
- DISADV: harder to compare results between diff. illness + may not include all domains considered important
- e.g. SAQ-7 (angina questionnaire)
- Generic
- UTILITY
PROM - patient reported outcome measure
Physical + mental health influences QoL + well-being
Many medicines improve quality NOT quantity of life
