Week 8 & 9 - Health Economics

Question 1

What are the 4 ways outcomes are measured

Answer 1

Outcomes refer to the effect on patients

1. Clinical indicators
2. QoL (quality of life)
3. Utility (QALY - quality adjusted life year)
4. Willingness to pay

Question 2

How does ‘clinical indicators’ measure outcomes

ACR - American College of Rheumatology

Answer 2

ACR response criteria measure improvement in tender / swollen joint counts + improvement in at least 3 of the following parameters:
- patient global assessment of disease activity
- physician global assessment of disease activity
- patient pain scale
- disability/functional questionnaire (Health Assessment Questionnaire Disability Index)
- acute phase reactant (ESR or C-Reactive Protein)
- measure CRP or erythrocyte sedimentation rate (ESR)

ACR >20 = 20% improvement in tender or swollen joint counts + improvement in at least 3/5 parameters
ACR <20 = patient didnt respond to treatment
ACR > 50 = good response
ACR > 70 = excellent response (most improvement)

ACR doesnt measure:
- Side effects:
- pain, fatigue, depression, reduced life expectancy
- Gluccorticoids: weight gain, skin thinning
- DMARDs: risk of infection, NV, liver toxicity

ACR and HAQ can be used to measure the effectiveness of the treatment

Question 3

How does ‘QoL’ measure outcomes for RA

Answer 3

Include Disease-specific measures include:

1. Health Assessment Questionnaire [HAQ]
   - combination of questionnaire, visual analgoue pain scale, and global health scale
   - self-reported covering 20 items in 8 domains
   - about ability to function, meausres diffciculty in performing daily activities e.g. grooming, shopping
   - rate pain and health from 0 to 100
   - improvement i function = ↓ in HAQ score
   SCORING:
   
   • score 0-1 = mild difficulties + moderate disability
   • score 1-2 = moderate to severe disability
   • score 2-3 = severe to vere severe disability
     - score 3 = unable to do things
2. DAS28
   - a disease specific QoL measure
   - combines CRP or ESR, no. of tender + swollen joints, and subjective health
   - only measures 28 joints (don’t include feet may have majority RA in feet but will have low score)
   SCORING:
   >5.1 = severe disease / high disease activity
   3.2-5.1 = moderate disaese activity
   <3.2 = low disease activity
   <2.6 = disease remission
3. AIMS and AIMS2
4. RAQoL

Question 4

What are the EULAR response criteria

Question 5

What are the indirect costs associated with RA

= how society is affected

Answer 5

The productcivity loss of society due to sickess

1. Mortality costs: premature mortality, loss of production due to death
2. Morbidity costs: loss of production due to sick leave, productivity impairment, unemployment

Question 6

WHat are the direct costs associated with RA

= costs of treating the illness

Answer 6

Direct Medical Costs:
(these can be fixed, semi-fixed, variable)
- medcines (variable)
- hospital stay
- primary care
- A&E
- staff (semi-fixed)
- electricity, building, gas etc. (fized)

Direct Non-medical Costs:
- transport to appointments
- paying for carers
-

Question 7

What are intangible costs

Answer 7

Things you can’t put a price on e.g. anxiety, pain, suffering

Question 8

How does using bDMARS or tsDMARDs affect costs and outcomes