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biostats > Econ Exam 2 > Flashcards

Econ Exam 2 Flashcards

1
Q

Cost Utility Analysis (CUA)

A

measures cost in dollars and outcomes in quality adjusted life year (QALY)
-known as a subset of CEA
-outcomes in natural health units
takes patients preferences or satisfaction (utilities) into account

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2
Q

Quality of Life

A

evaluation of all aspects of our lives including where we live, how and how we play and how we work

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3
Q

health-related quality of life

A

only those aspects of life that are dominated or significantly influenced by personal health or activities performed to maintain health

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4
Q

Genetic Instruments

A

Health status measures
preference based measures (utility measures)

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5
Q

Specific Instruments

A

Disease specific
population specific
function specific
condition specific

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6
Q

QALY

A

a measure of value and benefit of health outcomes
incorporates both the quantity (mortality,death) and quality (morbidity:disease states)

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7
Q

Why measure Utility?

A

patient satisfaction is related to financial implications
-patient choice of health plans
-patient recommendation to other patients
-malpractice claims

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8
Q

Why measure Utility? part 2

A

-Patient satisfaction is related to clinical implications
-patients desire to adhere to providers directions, appointments and comply with treatments

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9
Q

characterisitics of utility measurement

A

subjective, individualized, personal, a room for biases

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10
Q

Biases for self assessment

A

acquiescence-tendency to agree with any item
extremity:tendency to respond to highest/lowest response alternative
evasiveness-tendency to respond to middle alternative
carelessness: tendency to respond randomly or thoughtlessly to items
social desirability-tendency to respond in a conventional rather than truthful way

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11
Q

QALY calculation

A

Utility X Years of life

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12
Q

Methods to determine utilities

A

rating scale, standard gamble, time tradeoff

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13
Q

rating scale

A

a line with scaled markings (thermometer)

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14
Q

Adavantages of CUA

A

multiple outcomes can be compared (unlike CEA)
Incorporates mortality and morbidity into once unit of QALY without having to estimate monetary value of health outcomes

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15
Q

Disadvantages of CUA

A

difficulty in measuring accurate QALY/utility
Utility measurement is not a precise or scientific measurement
-CUA less commonly used

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16
Q

CUA is a pharmaeconomic analysis that measures costs in dollars and quality adjusted life year

A

True

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17
Q

utility score is?

A

the point where 2 options are nearly equal and you cannot decide between the 2

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18
Q

Acquiescence

A

always agree with any item, regardless of the content of the question

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19
Q

Extremity

A

tendency to respond to the highest or lowest response alternative

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20
Q

Evasiveness

A

tendency to respond to the middle alternative

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21
Q

Carelessness

A

tendency to respond randomly or thoughtlessly

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22
Q

Social Desirability

A

tendency to respond in a conventional rather than truthful ways or when subjects want to be perceived as a good patient

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23
Q

Cost-Benefit Analysis

A

compares both costs and benefits (outcomes) in monetary units
-used to aid public policy (government uses for economic welfare)

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24
Q

What is CBA used for now?

A

irrigation and flood control, wildlife, air quality
A vaccination program for children

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25
Q

Advantages of CBA

A

many different outcomes-can compare multiple programs
can determine which program has the greatest benefit

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26
Q

disadvantages of CBA

A

can lead to biased or inaccurate estimates of the outcomes

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27
Q

Cost Components of CBA

A

Direct medical
Direct non-medical

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28
Q

Benefits of CBA

A

Direct medical
Direct non-medical
Indirect: HC (human capital), WTP (willing to pay)
Intangible: WTP

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29
Q

CBA: Direct medical cost Ex:

A

Cost to visit pharmacy for asthma program
-Spend $100 for asthma program

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30
Q

CBA: Direct medical benefit

A

Benefit of reduction in the number of ER visit
-Save $2,000 to visit ER

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31
Q

Indirect Benefits-Human Capital (HC) Method

A

Increases (prevents the decrease) in productivity or earnings because of a program
Calculate: Wage rate and missed time (days or years)

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32
Q

HC Wage (income) and Missed time

A

-Uses income sources such as:
-census bureau
-Bureau of labor and stats
-self-report (paycheck)
-Includes fringe benefits-health insurance and life insurance paid

can use self report for missed days or years

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33
Q

HC has 2 types of wages?

A

A yearly wage rate (annual income)
A daily wage rate

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34
Q

A yearly wage rate used when?

A

Used for a program that would reduce long-term disability or death
-like a pneumococcal program

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35
Q

A daily wage rate used when?

A

Used for a program targeted at an acute chronic illness with short-term disability
-like episodes of asthma attacks

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36
Q

HC Disadvantage

A

Personal Wage differences-people say it should be based off the average population and not the specific patients
-Does not consider health related quality of life such as pain and suffering. Ex: menopause, headache, sore muscle

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37
Q

WTP-Willingness to pay method

A

to determine how much people are willing to pay to reduce the chance of an adverse health outcome
-incorporates patient preferences and intangible benefits

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38
Q

WTP Contingent Valuation (CV)

A

The respondents are asked to value a contingent or hypothetical intervention in dollar values
asked to value health care intervention in $$$

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39
Q

2 components of WTP

A
  1. Hypothetical Scenario
  2. Bidding Vehicles
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40
Q

Hypothetical Scenario includes:

A

a description of health care programs or intervention
amount of time the person should expect to spend
benefits the person should expect
-provides an accurate description

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41
Q

Bidding Vehicles include:

A

-Open ended questions
-Closed ended questions
-bidding games
-payment card

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42
Q

Open ended questions

A

-Used the least because of wide range of values or what values to put in

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43
Q

closed ended questions

A

uses only one WTP value
take it or leave it (Yes or No)

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44
Q

bidding games

A

several bids (usually 3 times) to reach a persons max wtp
time consuming
starts point bias
If Yes, ask another question regarding price

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45
Q

payment card:

A

provides a list of possible WTP amounts to choose from (usually from a table)
very easy and provides a range of values at the same time
introduces range bias: suggestion of values leads to influence

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46
Q

2 ways to present CBA:

A

Net benefit or net cost=subtraction
benefit to cost ratio or cost to benefit ratio=division

47
Q

net benefit=

A

total benefits - total costs

48
Q

net cost=

A

total costs - total benefits

49
Q

cost beneficial if?

A

net benefit >0 or net cost <0

50
Q

benefits to cost ratio

A

total benefits/total costs

51
Q

cost to benefit ratio

A

total costs/total benefits

52
Q

Ratio-cost beneficial when?

A

Benefit to Cost >1 or Cost to benefit <1

53
Q

Choose IRR (internal rate of return) if:

A

IRR > than the hurdle rate ->accept the project

54
Q

Humanistic Outcomes

A

patient reported outcome (PRO)
-comes directly from the patient without amendment or interpretation
measured by self-report or by interview of only patients response

55
Q

HRQoL

A

overall quality of life that is health related perceived by the patient
-it distinguishes health outcomes from financial status, family life, friendships, job satisfaction

56
Q

Importance of HRQoL

A

WHO: health is a state of complete physical mental and social well being and not merely the abscense of disease or infirmity

57
Q

3 methods to measure health states

A
  1. utility measures
  2. HRQoL Measures
  3. preference based classification
58
Q

Utility measures

A

preference based or choice based
Uses the standard gamble and time tradeoff
time consuming and resource intensive

59
Q

HRQoL Measures

A

non-utility or non-preference
surveys are multidimensional (multiple concepts) and do not result in once score
-complicates interpretation

60
Q

2 ways to measure HRQoL

A
  1. General/Generic Measures
  2. Disease-specific measures
    combo of both is recommended
61
Q

General measures

A

generic measures:
SF-36
SF-12
scores compared for many diseases
may not be sensitive to differences for every disease

62
Q

disease specific measures

A

condition specific measures
physical symptoms distress index
living with asthma questionnaire
-more narrow on patients views
cannot compare across pops.

63
Q

SF36

A

most common generic HRQoL instrument used in US
self evaluation of change in health during past year
includes questions on: pain, emotional, physical, limitations, social activities, energy and emotions

64
Q

4 dimensions of HRQoL?

A
  1. physical functioning
  2. psychological (mental) functioning
  3. Social/Role functioning
  4. General Health perception
65
Q

3 instruments of HRQoL?

A
  1. reliability
  2. validity
  3. responsiveness
66
Q

physical functioning?

A

observable limitations or disability
-energy level, bodily pain, activities of daily living

67
Q

physcological (mental) functioning?

A

Psychological distress
-anxiety, depression, moodiness, life satisfaction, cognitive function

68
Q

social functioning?

A

maintain social relationships
like social interactions

69
Q

role functioning?

A

duties and responsibilities that are limited due to health
like working, school or household duties

70
Q

general health perception

A

patients overall beliefs and evaluations
related to both patients perception on current health and future expectations

71
Q

Reliabillity?

A

consistency o
same score on multiple administration?
like test-retest, internal consistency, interrater

72
Q

reliability: test-retest

A

similarity of health status over time when no changes occur

73
Q

reliability: internal consistency

A

assess correlation (agreement) between responses to questions within the same domains
like vitality: physically tired or worn out?

74
Q

Reliability: Interrater

A

the correlation between 2 respondents of health status
like asking both mother and teacher

75
Q

T or F: all valid tests are reliable

A

True

76
Q

T or F: A reliable test may or may not be valid

A

True

77
Q

validity

A

true representation

78
Q

validity: content

A

face validity
if HRQoL offers adequate representation of the relevant variables
complete and relevant

79
Q

Validity: Criterion

A

predictive validity
correlate with or predict health outcomes

80
Q

High HRQoL scores predict?

A

less use of medical services

81
Q

Low HRQoL scores predict?

A

higher rates of mortality

82
Q

Validity Construct

A

Convergent, discriminant, known-group

83
Q

validity: Construct-convergent

A

determines whether use of different measures of the same construct provide similar results
ex: scores of mental health should be similar to scores of disease specific scores like bipolar

84
Q

validity: Construct-discriminant

A

if different measures and their constructs can be differentiated from others
EX: physical functioning is NOT expected to be highly related to mental functioning

85
Q

Validity Construct-known-group

A

determines differences between patient groups known
ex: anxiety-first time mothers vs women already given birth

86
Q

Responsiveness

A

captures information on change in health states
-Minimally important difference used (MID)

87
Q

MID:

A

smallest change or difference in an outcome measure that is perceived as beneficial and would lead to change in patients medical management

88
Q

preference based classification

A

a hybrid of the utility and HRQoL measures
-uses utility but based on math using predeveloped instruments
-less resource intensive

89
Q

common domains measure in health care services

A

clinicians scientific knowledge
quality of clinician patient communication
provision of humane interpersonal treatment
degree of patients trust

90
Q

Decision Analysis

A

compares different decision options
graphically displays choices
helps with selecting best or most cost effective option

91
Q

Step 1: identify specific decisions

A

-good study design
objective of study, decision makers, perspectives, period of time

92
Q

step 2: specify alternatives

A

new therapy vs standard
can compare more than 2 treatments

93
Q

step 3: draw the decision tree

A

branches, nodes are where the different options occur
choice node: square and is allowed
chance: circle
terminal: triangle and the final outcome is determined

94
Q

step 4 estimates:

A

specify costs, outcomes and probabilities

95
Q

ICER formula

A

C1-C2 / E1 - E2

96
Q

Markov Modeling

A

analyzes more complex outcomes and longer follow up periods

97
Q

transition

A

patients may move between health states over periods of time

98
Q

cycle (interval)

A

time period that is determined to be relevant to the specific disease or condition

99
Q

absorbing state

A

when patients cannot move to another health state (dies)

100
Q

Pharmaceutical services

A

functions done by a pharmacist that may or may not be associated with dispensing a particular prescription

101
Q

pharmacy service programs

A

clinical, cognitive, pharmaceutical, disease state, MTM (ALL OF THE ABOVE)

102
Q

PE study for pharmacy services

A

to determine whether the service is worthwhile financially
CBA is the most common to use

103
Q

Silo Mentality

A

only one budget or silo (pharmacy budget)
non-pharmacy health care costs such as ER and hospital can decrease because of better med management

104
Q

Budget Impact Analysis (BIA)

A

Technology!
to understand affordability of the new health care tech.
financial statements with or without new health care tech.

105
Q

primary cost component is?

A

acquisition costs
costs of admin and monitoring and costs to treat AE

106
Q

changes in disease related costs

A

can occur within time horizon (can offset new tech costs) or outside time horizon

107
Q

costs of tech presented on?

A

annual basis

108
Q

CUA is a subset of?

A

CEA

109
Q

CUA measures

A

quantity (mortality: death) and quality (QUALY)

110
Q

standard gamble: Alternative 1

A

YOU receive an intervention and can Die or be Healthy

111
Q

standard gamble: Alternative 2

A

YOU receive no intervention

112
Q

Choose Operation: point of indifference (use when not sure when to go with surgery) becomes the

A

UTILITY score

113
Q

If patient has 85% chance of living and 15% dying and wants to do the surgery: Is the Utility score 0.85 (True or False):

A

False there is no utility score since patient still chose an option (no point of indifference)

114
Q

Time trade off (choose to be healthy), calculate utility score?

A

point of indifference / time

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