Flashcards in Exam Deck (79):
What is the decision-tool to compare costs with consequences?
What does ECHO stand for?
Clinical (BP measures)
Humanistic consequences (outcomes/QOL)
"Can it work?" is an example of what?
Efficacy (phase II trials)
"Does it work?" is an example of what?
"Is it reaching those who need it?" is an example of what?
What is properly allocating resources, lowest cost/unit of output?
What is pharmacoeconomics?
Economic evaluation of pharmacotherapy
Tool to identify, measure, and compare costs and outcomes of use of pharmaceutical products and services
What is the equation for value?
Value = Benefits/costs
What do healthcare providers mean by added value?
What do healthcare providers mean by what is it going to cost?
What is PEC?
What are the essential elements of economic analyses?
What are the three pieces that determine cost of therapy?
What is identification in determining cost of therapy?
All relevant resources consumed by intervention need to be identified
What is measurement in determining cost of therapy?
Magnitude of resource consumption, in numbers
What is valuation in determine cost of therapy?
Placing monetary value on quantified resource consumptions
What are tangible costs and benefits?
Direct medical costs/benefits
Direct non-medical costs/benefits
What are intangible costs and benefits?
Unquantifiable costs and benefits
-Improved health after treatment
-Pain and suffering associated with tx
What are direct medical costs?
Home medical visits
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
What are indirect costs?
Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity b/c of premature mortality
What are intangible costs?
Pain and suffering
What is the Drummond classification of costs?
Health care sector costs
Other sector costs
Patient and family costs
What are sources of cost?
Third part vendors
Biomedical, biopharmaceutical and pharmaceutical companies
Patient and caregiver reported
Tertiary data sources
Who are payers?
Managed care providers
Pharmacy benefit managers
Who are third party vendors?
Purchase proprietary data from variety of sources and aggregate
Group purchasing organizations
Who are providers?
Pharmacies, hospitals, etc
Who are tertiary data sources?
Micromedex contains Red Book Prices (AWP)
What are types of hospital costing?
Disease specific per diem (daily cost)
What is micro-costing?
Each component of resource used quantified, measured, valued
What is case-mix group?
Gives cost for each category of case/type of patient
Accounts for LOS
What is disease specific per diem?
Gives mean daily cost for treatment of certain diseases
What is per diem hospital costing?
Mean daily cost for all patients
Which type of costing is the most precise?
An ambulance cost is what type of cost?
Direct medical cost
Improved health after treatment would be what type of cost?
What is the main goal of tracking costs and outcomes?
Not to mislead policy maker
When do we use short-term tracking?
In hospital - to discharge
When do we use medium term tracking?
Payer - 1-5 years
When do we use long term tracking?
Patients - lifetime
What are the two types of differential timing costs?
Cost standardization-past costs to present
Discounting-future costs to present
What is a short term discounting cost?
< 1 yr, really no need
What is a longer-term tracking discounting cost?
Why do we discount/standardize?
Inflation - $ today worth more dollar in future
People would rather have certain benefit today than one in future
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
What are the types of PEC analysis?
What are the costs and outcomes of cost-minimization?
Costs = monetary units
Outcomes = assumed to be equivalent
What are the costs and outcomes of cost-effectiveness
Costs = monetary units
Outcomes = naturals units (life years saved)
What are the costs and outcomes of cost-benefit?
Costs = monetary units
Outcomes = monetary units
What are the costs and outcomes of cost-utility?
Costs = monetary units
Outcomes = Quality-adjusted life years
What is the most common type of PEC analysis?
When is a cost-effectiveness analysis used?
Limited budget and have range of options w/in a field
How must the outcomes compare in a cost-effectiveness analysis?
Outcome is same unit
What does a cost-effectiveness analysis compare?
Costs and consequences of two alternative treatments
What is the calculation for cost-effectiveness?
ICER (incremental cost-effectiveness ratio)
(Cost1 - Cost2) / (Outcome1 - Outcome 2)
1 = new drug
2 = comparator
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
What intervention is said to not be cost effective?
Higher cost and less effective
When is an ICER positive?
New tx more expensive AND more effective
New tx less costly and less effective
Generally want smaller ICER
When is an ICER negative?
New tx less costly and more effective
New tx more costly AND less effective
When are cost-effectiveness analysis most applicable?
Comparing costs/outcomes of 2+ alternative HTN med
Compare 2+ alternative programs to prevent mortality
What is a surrogate outcome?
Easy to measure/obtain
Needs to be related to hard outcome
In a CEA, what should be included in the methods?
Explicit description of costs/consequences
Methods and sources of data
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
What do negative ICER scenarios represent?
New medication/service dominant
New medication/service being dominated
What are the parts of QALY?
Life gained (mortality)
Quality of that life gained (morbidity)
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
What are problems with CUA?
Most difficult/ time-consuming/ expensive economic evaluation
How is QALY usually measured?
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)
What is the focus of QALY?
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
How do we obtain utility weights?
Utility is preference
Direct measurement from patients/general public
What are the 3 methods for measuring utility?
Standard gamble (SG)
Time trade-off (TTO)
Visual analog scale (VAS)
A CUA is a type of what other analysis?
What is the SG based on?
How many alternatives are available in a standard gamble?
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
What is alternative 2 in a SG?
Certain outcome of chronic state i for life