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Flashcards in Exam Deck (79):
1

What is the decision-tool to compare costs with consequences?

ECHO

2

What does ECHO stand for?

Economic (money)
Clinical (BP measures)
Humanistic consequences (outcomes/QOL)

3

"Can it work?" is an example of what?

Efficacy (phase II trials)

4

"Does it work?" is an example of what?

Effectiveness

5

"Is it reaching those who need it?" is an example of what?

Availability

6

What is properly allocating resources, lowest cost/unit of output?

Efficiency

7

What is pharmacoeconomics?

Economic evaluation of pharmacotherapy
Tool to identify, measure, and compare costs and outcomes of use of pharmaceutical products and services

8

What is the equation for value?

Value = Benefits/costs

9

What do healthcare providers mean by added value?

Cost-effectiveness

10

What do healthcare providers mean by what is it going to cost?

Budget impact

11

What is PEC?

Pharmacoeconomics

12

What are the essential elements of economic analyses?

Cost determinants
Measuring costs
Discounting costs
Sensitivity analysis

13

What are the three pieces that determine cost of therapy?

Identification
Measurement
Valuation

14

What is identification in determining cost of therapy?

All relevant resources consumed by intervention need to be identified

15

What is measurement in determining cost of therapy?

Magnitude of resource consumption, in numbers

16

What is valuation in determine cost of therapy?

Placing monetary value on quantified resource consumptions

17

What are tangible costs and benefits?

Direct medical costs/benefits
Direct non-medical costs/benefits
Indirect costs/benefits

18

What are intangible costs and benefits?

Unquantifiable costs and benefits
-Improved health after treatment
-Reduced pain
-Pain and suffering associated with tx

19

What are direct medical costs?

Medications
Medication monitoring
Medication administration
Pt counseling/consultations
Diagnostic tests
Hospitalizations
Clinic visits
ED visits
Home medical visits
Ambulance services
Nursing services

20

What are direct nonmedical costs?

Travel costs to receive health care
Nonmedical assistance related to condition (Meals-on-wheels, homemaking service)
Hotel stays for patient/family for out-of-town care
Child care services for children of patients

21

What are indirect costs?

Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity b/c of premature mortality

22

What are intangible costs?

Pain and suffering
Fatigue
Anxiety

23

What is the Drummond classification of costs?

Health care sector costs
Other sector costs
Patient and family costs
Productivity costs

24

What are sources of cost?

Payers
Third part vendors
Providers
Biomedical, biopharmaceutical and pharmaceutical companies
Patient and caregiver reported
Tertiary data sources

25

Who are payers?

Managed care providers
Pharmacy benefit managers
Medicare
Medicaid

26

Who are third party vendors?

Purchase proprietary data from variety of sources and aggregate
Group purchasing organizations
Management companies

27

Who are providers?

Health systems
Individual providers
Pharmacies, hospitals, etc

28

Who are tertiary data sources?

Micromedex contains Red Book Prices (AWP)

29

What are types of hospital costing?

Micro-costing
Case-mix group
Disease specific per diem (daily cost)
Per diem

30

What is micro-costing?

Each component of resource used quantified, measured, valued

31

What is case-mix group?

Gives cost for each category of case/type of patient
Accounts for LOS

32

What is disease specific per diem?

Gives mean daily cost for treatment of certain diseases

33

What is per diem hospital costing?

Mean daily cost for all patients

34

Which type of costing is the most precise?

Micro-costing

35

An ambulance cost is what type of cost?

Direct medical cost

36

Improved health after treatment would be what type of cost?

Intangible

37

What is the main goal of tracking costs and outcomes?

Not to mislead policy maker

38

When do we use short-term tracking?

In hospital - to discharge

39

When do we use medium term tracking?

Payer - 1-5 years

40

When do we use long term tracking?

Patients - lifetime

41

What are the two types of differential timing costs?

Cost standardization-past costs to present
Discounting-future costs to present

42

What is a short term discounting cost?

< 1 yr, really no need

43

What is a longer-term tracking discounting cost?

1+ year

44

Why do we discount/standardize?

Inflation - $ today worth more dollar in future
People would rather have certain benefit today than one in future

45

What is the ISPOR equation for discounting?

PV = FC x DF (n,r)
PV = present value
FC = future costs
DF = discount factor
n = number of years
r = discount rate

46

What are the types of PEC analysis?

Cost-minimization
Cost-effectiveness
Cost-benefit
Cost-utility

47

What are the costs and outcomes of cost-minimization?

Costs = monetary units
Outcomes = assumed to be equivalent

48

What are the costs and outcomes of cost-effectiveness

Costs = monetary units
Outcomes = naturals units (life years saved)

49

What are the costs and outcomes of cost-benefit?

Costs = monetary units
Outcomes = monetary units

50

What are the costs and outcomes of cost-utility?

Costs = monetary units
Outcomes = Quality-adjusted life years

51

What is the most common type of PEC analysis?

Cost-effectiveness

52

When is a cost-effectiveness analysis used?

Limited budget and have range of options w/in a field

53

How must the outcomes compare in a cost-effectiveness analysis?

Outcome is same unit

54

What does a cost-effectiveness analysis compare?

Costs and consequences of two alternative treatments

55

What is the calculation for cost-effectiveness?

ICER (incremental cost-effectiveness ratio)
(Cost1 - Cost2) / (Outcome1 - Outcome 2)
1 = new drug
2 = comparator

56

When are interventions said to be cost-effective?

Less expensive AND more effective
Less expensive AND at least as effective
More expensive AND more effective

57

What intervention is said to not be cost effective?

Higher cost and less effective

58

When is an ICER positive?

New tx more expensive AND more effective
New tx less costly and less effective
Generally want smaller ICER

59

When is an ICER negative?

New tx less costly and more effective
New tx more costly AND less effective

60

When are cost-effectiveness analysis most applicable?

Comparing costs/outcomes of 2+ alternative HTN med
Compare 2+ alternative programs to prevent mortality

61

What is a surrogate outcome?

Intermediate
Easy to measure/obtain
Needs to be related to hard outcome

62

In a CEA, what should be included in the methods?

Explicit description of costs/consequences
Perspective analysis
Methods and sources of data

63

What are limitations to ICER?

Relatively small positive ICER driven by small increase in cost OR large gain in effectiveness
Conveys limited information to policy-makers

64

What do negative ICER scenarios represent?

New medication/service dominant
OR
New medication/service being dominated

65

What are the parts of QALY?

Life gained (mortality)
AND
Quality of that life gained (morbidity)

66

When should a cost-utility analysis be used?

When HRQOL is most/an important outcome
When program/service affects mortality and morbidity and you want common unit to measure both
When program/service have wide range of different kinds of outcomes and you want common unit of output for comparison
Limited budget, policy-maker must determine which program/service to reduce/eliminate to free-up funding for new program/service
Allocate limited resources optimally and using constrained optimization to maximize health gain achieved

67

What are problems with CUA?

Most difficult/ time-consuming/ expensive economic evaluation

68

How is QALY usually measured?

Years

69

What is the scale for QALY?

Anchored on scale from 0 (death) to 1 (perfect health)
Can be adjusted to reflect states worse than death (< 0)

70

What is the focus of QALY?

Health states

71

How is QALY calculated?

If utilities are same, then difference in QALYs is difference in AUC
If utilities are different, then adjust to estimate incremental QALYs
Life gained x utility

72

How do we obtain utility weights?

Utility is preference
Through literature
Direct measurement from patients/general public

73

What are the 3 methods for measuring utility?

Standard gamble (SG)
Time trade-off (TTO)
Visual analog scale (VAS)

74

A CUA is a type of what other analysis?

CEA

75

What is the SG based on?

Utility theory

76

How many alternatives are available in a standard gamble?

2

77

What is alternative 1 in a standard gamble?

Tx w/2 outcomes:
-Returned to perfect health and lives for additional x years
-Patient dies immediately

78

What is alternative 2 in a SG?

Certain outcome of chronic state i for life

79

How is SG probability manipulated?

Until subject indifferent b/t two alternatives which is preference score