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Objectives Flashcards

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1
Q

Where are cohort and case-control studies in the hierarchy of evidence?

A 
Best --> Worst
Meta-analysis
Systemic reviews
Critically appraised sources
RCTs
Cohort
Case control
Case reports
Expert opinion
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2
Q

What are the types of cohort studies?

A

Prospective (study starts at the exposure)
Retrospective (study starts after disease progression)
Ambidirectional (study starts at the beginning of the disease after exposure)

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3
Q

What are the types of cohorts?

A

Closed
Fixed
Open

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4
Q

What is a closed cohort?

A

Group followed from start tp pre-defined time end

People cannot enter or leave

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5
Q

What is a fixed cohort?

A

When follow-up time is same for all group members

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6
Q

What is an open cohort?

A

People can enter or leave cohort over chosen time-frame

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7
Q

What is cohort exposure?

A

Can vary based on levels/doses

Can also select non-exposed group separately, but must be as equivalent to exposed as possible

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8
Q

What are cohort outcomes?

A

ECHO

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9
Q

What does ECHO stand for?

A

Economic (Direct and indirect costs)
Clinical (A1c, asthma control, BP)
Humanistic outcomes (QoL, satisfaction w/care)

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10
Q

What is a case-control study?

A

Retrospective

Both cases and controls look back at the exposed and unexposed groups

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11
Q

In a case-control study, what results are we looking for?

A

Physical

Pathological

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12
Q

In a case-control study, why is accuracy important?

A

Do not want to include false positives

Be as restrictive as possible

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13
Q

In a case-control study, where does study information come from?

A 
Hospital records
Clinic patient rosters
Death certificates
Cancer registries
Birth registries
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14
Q

In a case-control study, what are the types of cases?

A

Incident cases

Prevalent cases

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15
Q

What are incident cases?

A

New cases

If interested in causes of disease

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16
Q

What are prevalent cases?

A

Old cases

If wanting to know about factors affecting duration

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17
Q

In a case-control study, what are controls?

A

Sample of population that produced cases (study base)

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18
Q

What is a good control?

A

Members of the controls would be a case if they developed the condition

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19
Q

What are sources of controls?

A

Population
Hospital/clinic
Friend/spouse/relative

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20
Q

What should the ratio of control to cases be?

A

1:1 - 1:4

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21
Q

What are the ways to analyze cohort studies?

A

Incidence rate
Risk ratio
Risk difference
Odds ratio

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22
Q

What is an incidence rate?

A

Rate of incidence in both exposed and unexposed groups

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23
Q

What is a risk ratio?

A

Ratio of incidence rates in both the exposed and unexposed groups (a/a+b)/(c/c+d)

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24
Q

What does a risk ratio of 1 mean?

A

No difference

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25
What does a risk ratio > 1 mean?
Increased risk
26
What does a risk ratio of < 1 mean?
Decreased risk
27
What is risk difference?
Exposed minus the unexposed rates
28
What is an odds ratio?
Represents the odds that an outcome will occur given a particular exposure compared to the odds of the outcome occurring (a/b)/(c/d)
29
What is an experiment?
Series of observations made under conditions controlled by scientists
30
What is a randomized experiment?
Experiment in which units assigned to receive treatment by random process
31
What is an observational study?
Simply observes size and direction of relationship among variables
32
What is random sampling?
Makes a sample of subjects similar to a population
33
What is a random assignment?
Makes sample of subjects similar to each other
34
What are institutional review boards (IRBs)?
Required for institutions who experiment on humans | Reviews study protocol to ensure Belmont report adhered to
35
What is a type I error?
Finding association when there is not | False positive
36
What is a type II error?
Finding an association when there is | False negative
37
What is an alpha error?
Type I error Same as p-value Usually findings < 0.05 are significant
38
What is a beta error?
Type II error
39
How is power calculated?
1-beta | Usually set at 20% (80% power)
40
What is representative sampling?
Sample that looks like population
41
What are types of representative samples?
Random | Stratified random
42
What is random sampling?
Potential subjects have non-zero chance of being selected | Requires access to everyone in population
43
What is stratified random sampling?
Perform random sample of individuals based on a certain set of characteristics
44
What are non-representative sampling?
Most common type of sample, convenience sample
45
What are types of non-representative sampling?
Purposively sample: Non-random Only selects people with a defining characteristic
46
What are the types of observational studies?
Cross-sectional | Quasi-experimental
47
What is a cross-sectional study?
Gather info at 1 point in time (cross-section) Descriptive Can measure prevalence well Associations b/n DV and IV
48
Which observational study can identify causal relationships?
Quasi-experimental
49
What is a quasi-experimental study?
Treatment controlled by researcher | Subjects not randomly assigned to treatment
50
Which observational study has high internal validity?
Quasi-experimental
51
What do quasi-experimental studies need to infer causation?
More data than RCTs | More assumptions in analysis to infer causation
52
What is bivariate analyses?
Measures association between 2 variables of interest
53
What is multivariate analyses?
Measures association between a DV and IVs
54
What is the most common type of statistical analyses?
Paramteric
55
What are the most common types of parametric statistics?
``` Mean SD Correlation T-test ANOVA Linear regression ```
56
What assumptions are made in parametric statistics?
Variable is quantitative Linear relationship b/n DVs and IVs Normality of error distribution
57
What type of statistics has a DV that is normally distributed?
Parametric statistics
58
What are types of non-parametric statistics?
``` Chi-squared Fisher's exact Kruskal Wallis Wilcoxon Mann Whitney Spearman Friedman Logistic regression ```
59
What is nominal data?
Used for labeling variables, without any quantitative data (nominal sounds like name)
60
What are examples of nominal data?
Color Sex Location
61
What is dichotomous data?
Data with only 2 categories Yes/no Male/female
62
What is ordinal data?
The order of the data is important, but the difference between the values is not
63
What are examples of ordinal data?
How do you feel? (Okay, happy, very happy)
64
What is interval data?
Numeric scales in which we know the order and exact difference between the values
65
What is an example of interval data?
Temperature
66
What is ratio data?
Tells us about the order, the exact value between units, AND has an absolute zero
67
What are examples of ratio data?
Ht | Wt
68
What are the 3 pieces of cost determinants?
Identification Measurement Valuation
69
What are types of hospital costing?
Micro-costing Case-mix group (accounts for LOS) Disease specific per diem (daily cost) Per diem (mean daily cost for all patients)
70
What is the most precise type of hospital costing?
Micro-costing
71
What is the least precise type of hospital costing?
Per diem
72
What are the tangible costs of pharmacoeconomic analyses?
Direct medical costs Direct non-medical costs Indirect costs
73
What are direct medical costs and benefits?
``` Medications Medication monitoring Medication administration Patient counseling and consultations Diagnostic tests Hospitalizations Clinic visits ED visits Home medical visits Ambulance services Nursing services ```
74
What are direct non-medical costs?
Travel costs to receive health care Nonmedical assistance related to condition Hotel stays for patient or family for out-of-town care Child care services for children of patients
75
What are indirect costs and benefits?
Lost productivity for patient Lost productivity for unpaid caregiver Lost productivity because of premature mortality
76
What are intangible costs and benefits?
Unquantifiable costs and benefits Improved health after treatment Reduced pain Pain and suffering associated with treatment
77
What are short-term tracking of costs and outcomes?
Hospital to d/c
78
What are medium-term tracking of costs and outcomes?
Payer | 1-5 years
79
What are long-term tracking of costs and outcomes?
Patients | Life-time
80
What are the outcomes of CMA?
Assumed to be equivalent
81
What are the outcomes of CEA?
Natural units (life years saved)
82
What are the outcomes of CBA?
$
83
What are the outcomes of CUA?
QALY
84
What are the questions answered by CBA?
Which programs should be implemented | How much or what combination of outputs should be produced
85
What are the methods of measuring CBA?
Human capital | Willingness to pay
86
What is the simplest evaluation?
CMA
87
How is CMA used?
Compares 2+ alternative treatments that produce equivalent outcomes Choose option with lowest cost
88
What is net benefit?
Total benefit - total costs
89
What benefit:cost ratio is preferred?
> 1
90
What does ICER stand for?
Incremental cost-effectiveness ratio
91
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
92
When is an ICER positive?
New tx more expensive AND more effective New tx less costly AND less effective Want smaller ICER
93
When is an ICER negative?
New tx less costly AND more effective | New tx more costly AND less effective
94
When is an ICER dominant?
Less costly AND more effective
95
When is an ICER dominated?
More costly AND less effective
96
What is a type of CEA?
CUA
97
What is QALY?
Combination of quantity life gained (mortality) AND Quality of the life gained (morbidity)
98
How do we measure quality of life gained?
Scale from 0 (death) - 1 (perfect health)
99
What are the disadvantages of a CUA?
Most difficult Most time consuming Most expensive
100
What are the ways to estimate utilities?
Visual analog scale (VAS) Standard gamble (SG) Time Trade-Off (TTO)
101
What is the VAS?
Easiest method to directly obtain utilities
102
What is a standard gamble?
Based on utility theory | 2 alternatives
103
What is TTO?
Simpler, easier to use then SG | Subject offered 2 alternatives and they get to choose
104
What is a latent variable?
An unobservable phenomenon that takes on a specific value under a set of conditions
105
What are examples of latent variables?
Trust in physicians QoL Health literacy levels
106
What is reliability?
Proportion of variance attributable to the true score of the latent variable
107
What is a true score?
A scale developed to measure a latent variable is intended to estimate its actual magnitude at the time and place of measurement for each subject
108
What does reliability measure?
Same result
109
What are the types of validity?
Content validity Criterion-related validity Construct validity
110
What question does validity answer?
Is the latent variable the underlying cause of item covariation
111
What is content validity?
Extent to which a set of items reflects content domain
112
When does a scale have content validity?
When items are a randomly chosen subset of the universe of appropriate items
113
What is criterion-related validity?
Scale related to a gold standard | Also called predictive validity
114
What does construct validity measure?
Measures theoretical relationship of a variable to other variables
115
What are the two ways to measure self-reported HRQoL?
Generic | Disease specific
116
What are advantages of generic HRQoL?
Broadly applicable Summarizes a range of concepts May detect unanticipated effects
117
What are disadvantages of generic HRQoL?
May not be responsive to changes in health May not be relevant for specific populations Results may be difficult to interpret
118
What are advantages of disease specific HRQoL?
More relevant for specific populations | More responsive to changes in health
119
What are disadvantages of disease specific HRQoL?
Cannot compare across populations | Less likely to detect unanticipated effects

Pharmacoeconomics (5 decks)

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