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Pharmacoeconomics > Exam 1 > Flashcards

Exam 1 Flashcards

(65 cards)

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0
Q

Medicaid

A

Low income

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1
Q

Medicare

A

Elderly

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2
Q

Chip

A

Children’s health insurance program

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3
Q

4 types of cost

A

Direct medical
Direct non medical
Indirect cost
Intangible

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4
Q

Ex direct medical costs

A 
Medication
Administration
Hospitalization
Diagnostic tests
Counseling
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5
Q

Ex direct non medical costs

A

Travel costs
Hotels
Child care
Meals on wheels

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6
Q

Examples indirect costs

A

Lost productivity patient care giver

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7
Q

How measure indirect costs

A

Human capital method

Willingness to pay

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8
Q

Human capital method

A

Based on individual earnings capacity

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9
Q

Willingness to pay

A

How much willing to pay to reduce likelihood of disease or avoid a negative outcome

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10
Q

Intangible costs

A

Pain and suffering
Stress
Fatigue
Anxiety

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11
Q

Incremental cost

A

Extra costs needed to purchase an additional unit of effect. Units get more costly as you march along

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12
Q

Opportunity costs

A

The value of the alternative that was forgone

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13
Q

Discounting

A

Value of money decreases over time

Need to use if looking at costs benefits over more than 1 year

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14
Q

Outcomes

A

Intermediate vs final

LDL levels vs death

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15
Q

Efficacy vs effectiveness

A

Efficacy like clinical trial with controlled environment etc

Effectiveness how works in the real world

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16
Q

Cost minimization

A

Need to prove outcomes are equivalent. If not cannot use.

Choose least costly alternative

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17
Q

Equivalency

A

Measure on qalys dollars

Also should consider safety factors

Assume inequivalent and need to prove

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18
Q

Cma. When use

A

Generic vs brand
Routes of admin
Admin settings
Antibiotic therapies

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19
Q

CBA

A

Values of resources consumed with value of outcomes benefits

Always valued in dollars

Can compare unrelated therapies but outcome must have common link

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20
Q

CBA benefit analysis

3 types

A

Net benefit
Net present value
Ratio analysis

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21
Q

Net benefit

A

Total benefits - total costs

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22
Q

Net present vale

A

Total benefitsdiscount rate - total costdiscount rate

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23
Q

CBA ratio analysis

A

Total benefits/total costs

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24
Discount rate
Needed when analysis longer than 1 year
25
CBA Ratio vs net benefit
Ratio good for comparing 2 different programs Net benefit used when need to know magnitude and exact $
26
Cost effectiveness analysis
Used for alternative treatments that have common measure of effect Outcomes must be measured in same clinical units Choose option with least cost per measured outcome Must be within a disease state
27
Cost effectiveness grid
Helps choose and categorize. 2 obvious outcomes. 2 outcomes that need more analysis
28
CER and ICER
Cost effectiveness ratio | Incremental CER
29
How evaluate effectiveness for CER
ID clinically relevant outcomes Prefer final outcomes
30
Units of CER
Cost per successful case Cost per effective therapy Per life year gained
31
Units if ICER
Cost per additional life
32
Definition of effectiveness important in CER analysis
Need to define desired outcome Could be just success Could be success plus success with side effects
33
Cost Utility Analysis CUA
Sub type of CEA but uses utilities instead of $ Cannot use intermediate outcomes - need final outcomes Often use QALYs for $ Patient perspective important
34
Define utility
Numbers that represent strengths of individuals preferences for outcomes in the face of uncertainty
35
Problem with CUA
Quality of life is subjective
36
Sources for determining utility
Literature Judgment (expert panel) Psychometric theory (direct from subjects)
37
Decision tree
Roadmap for making a decision Organizes the decision process
38
``` Decision tree Choice node Chance node Terminal node Branch Decision path Rollback Estimated average cost ```
Choice blue square Chance green circle different probabilities Terminal red triangle
39
Steps for decision tree
ID decision ( timeframe and perspective) Draw tree Assess probability Determine value of each outcome ($ CER or QALY) Calculate cost per treatment (rollback) Determine robustness (sensitivity analysis)
40
If given probabilities what type of analysis?
Try decision tree
41
4 types of analyses
Cma CBA CEA Cua
42
Types of perspectives
``` Societal Third-party payer Institutional Pharmacy dept Individual ```
43
Types of outcomes
Clinical - intermediate and final Economic - direct, indirect, intangible Humanistic - quality of life, satisfaction ( very subjective) ECHO model
44
How to measure health - types of health status instruments
General survey vs disease specific survey
45
Determinants of health. Blum's model
Environment Lifestyle Heredity Medical care In order of importance (ELHM)
46
Quality of life vs health-related quality of life
QoL - subjective, particular to each individual HRQoL - specific to effect of illness and treatment - as perceived by the patient
47
Dimensions of health
Physical (capacity to perform physical) Mental ( feeling states) Social (participation and role function) Spiritual (not commonly included)
48
How measure health
Utility - value of a particular health state, measured by assigning preferences to health states Psychometric - how judge physical attributes for which there are no physical scales ( attitudes beliefs behavior knowledge)
49
How measure utility
``` Standard gamble (probability p) Time trade-off (h = x/t) Rating scale (like thermometer) ```
50
Essential properties of psychometrics
Reliable Responsive Valid
51
Define scaling and 4 scale typed
Scaling - assigning # to item responses NOIR Nominal - qualitative (name, zip code, m or f) Ordinal - rank order (better or worse) Interval - number of how much better or worse (zero is arbitrary) Ratio - how much better or worse by magnitude (zero is meaningful)
52
Advantages of general health status instrument
Can apply across all health states Can do broad comparisons (across different diseases) May detect unanticipated effects
53
Disadvantages of general health status instruments
May not be responsive to changes in health May not be relevant for specific population May be difficult to interpret
54
Advantages of disease specific health instruments
More relevant for specific population | More responsive to changes in health status
55
Disadvantages of disease specific health instruments
Cannot compare across populations | Cannot detect unanticipated effects
56
Dimensions of SF-36
``` Physical functioning Role limitations due to physical conditions Bodily pain Social functioning Mental health Role limitations due to emotional problems Vitality General health perceptions ```
57
Validity
Measures what it is supposed to measure and not what not to measure Face validity - makes sense Criterion validity - compares measure to external criteria like clinical assessment Construct validity - results align across domains Content validity - comprehensive
58
Construct validity - 3 types
Convergent - when scales used to measure mental health are highly related (correlated) to the mental factor Discriminant - scales to measure one aspect like physical health differ in their relationship to the physical health factor and the mental health factor Known groups
59
Responsiveness
Ability of health measure to detect changes in health status over time when changed do occur Floor ceiling effect. Level of measurement (likely)
60
Reliability
Ability to obtain same results under different circumstances for an individual (consistency) Need to be reliable to be valid
61
Types of reliability
Internal consistency - correlation across items that address same domain Test-retest Inter-rater reliability
62
How administer surveys?
``` Self-administration Mail administration Interview Telephone Computer-assisted Proxy reporting Mixed modes ```
63
Markov model compared to decision tree analysis
More complex Accommodates many cycles and intervals Transition between health states - can cycle back Continually transition until absorbing state
64
Steps in Markov modeling
``` Choose health states Determine possible transitions Choose cycle length and how many cycles Estimate probabilities of transitions Estimate costs and outcomes associated with each option ```

Pharmacoeconomics (1 decks)

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