Economic Evaluation In Healthcare

Question 1

What is economic evaluation?

Answer 1

Comparative analysis of the choices in terms of costs and consequences to aid priority setting and resource allocation.

Question 2

What is the process of economic evaluation?

Answer 2

Identify
Measure
Value
Compare

Question 3

What are the sources used for economic evaluation?

Answer 3

NICE provides recommendations for the use of medicines based on a review of clinical and economic evidence.
Scottish Medicine Consortium

Question 4

What are the types of economic evaluation?

Answer 4

Cost effectiveness
Cost utility
Cost benefit

Question 5

What is cost effectiveness?

Answer 5

Comparing interventions based on an appropriate single common variable based on a better health outcomes like number of years gained or number quitting smoking.

The inputs are the cost of intervention and the change in the health outcome with the new intervention.

Question 6

What is cost utility?

Answer 6

Comparing the costs of different outcomes based on utility based units that are the units related to a person’s wellbeing typically in QALY.

Question 7

What is cost benefit?

Answer 7

Analysis of all the outcomes such as health and quality of life between two interventions based on the monetary value.

Question 8

What is the most comprehensive economic evaluation analysis?

Answer 8

Cost benefit which takes a societal perspective and measures all the outcomes including health, quality of life and societal impacts like time off work in monetary units.

Question 9

Where does data for economic evaluations come from?

Answer 9

Obtaining primary data by conducting RCTs
Non-randomised studies such as before-and-after
Relying on existing data and secondary data from NICE

Question 10

What are the costs considered in economic evaluation?

Answer 10

Checklist of the costs and consequences based on all the resources consumed such as:

-> Costs to the healthcare sectors for operating staff, equipment and the premises
-> Costs to patients and family for travel time, anxiety and operating equipment
-> Costs to other sectors such as social services and societal productivity loss

Question 11

What are the ideal aims in economic evaluation?

Answer 11

Change in health state such as Quality of life state for patient/family
Resources saved for the health sector, patient and family, or other sectors.

Question 12

What is direct cost?

Answer 12

Costs of an intervention through the manufacturing, premises, staff salary and travel costs.

Question 13

What is indirect cost?

Answer 13

Missed wages due to illness.

Question 14

What is cost minimisation analysis?

Answer 14

Comparing the monetary value of different interventions which have an assumed equal health outcomes to choose the least cost analysis. It is not a full form of economic evaluation and it is used when prior evidence suggests that outcomes are equal.

Question 15

What are the benefits of cost-effectiveness analysis?

Answer 15

Straightforward to carry out and uses data from RCTs.

Question 16

What are the drawbacks of cost-effectiveness analysis?

Answer 16

Only looks at a single health outcome despite interventions producing multiple outcomes
Cannnot compare disparate alternatives, which means those that are distinctly different.

Question 17

What are the limitations of using RCTs for data in economic evaluation?

Answer 17

They have a limited time horizon

Question 18

What is data modelling?

Answer 18

Visual representation of data sets from literature which can show costs and outcomes of the programme with a comparator.

Question 19

What is the issue with using data modelling for economic evaluation?

Answer 19

May be issues in data collection and synthesis.

Question 20

How is cost-effectiveness calculated?

Answer 20

Incremental cost-effectiveness ratio based on:

Cost of new treatment - cost of old treatment/ effectiveness of new treatment - effectiveness of old treatment

Question 21

What happens in a cost-effectiveness analysis if only one factor is low?

Answer 21

The intervention with the lowest incremental cost-effectiveness ratio should be chosen based on a ceiling ratio.

Question 22

What is ceiling ratio?

Answer 22

The maximum willingness to pay for a benefit, for an intervention to be considered cost-effective.

Question 23

What are QALY league tables?

Answer 23

Procedures are ranked based on QALY, where those with the lowest cost receive the highest priority.

Question 24

What are the issues with QALY league tables?

Answer 24

There is a lack of consideration for the assumptions producing the ratios
Uses a list based approach that ignores opportunity cost and margin gain

Question 25

What is opportunity cost?

Answer 25

The value of the alternative.

Question 26

Why is cost-benefit analysis useful?

Answer 26

Allows comparison of both healthcare outcomes and non-healthcare outcomes, making it useful for allocating a global budget. An important consideration is whether QALY are an appropriate measure.