Phase 3B

Question 1

What is opportunity cost?

Answer 1

To spend resources on one activity means sacrifice in opportunities elsewhere (e.g. money for heart transplant reduces money for hip replacements).

Question 2

What is economic efficiency?

Answer 2

Resources are allocated between activities to maximise benefit.

Question 3

What is economic equity

Answer 3

What is fair and just.

Question 4

What is equity-efficiency trade off?

Answer 4

Improving equity may lead to loss of efficiency.

Question 5

What is economic evaluation

Answer 5

Assessment of efficiency of activities (comparative study usually).

Question 6

Ways to measure health benefits?

Answer 6

Natural units e.g. pain score.
Quality adjusted life years
Monetary value

Question 7

What is a quality adjusted life year?

Answer 7

Length in years X quality.

e.g. 1 QALY = 1 year of perfect health.

Question 8

4 ways for economic evaluation

Answer 8

Cost-effectiveness - outcome is natural unit e.g. pain score.
Cost-utility - outcome measured in quality adjusted life years.
Cost-benefit - outcome measured in monetary units.
Cost-minimisation - minimise cost measurement.

Question 9

What is incremental analysis

Answer 9

Everything is relative so there must always be a comparison e.g. New imaging technique V old technique.

Question 10

3 domains of PH

Answer 10

Improving services
Health protection
Health improvement

Question 11

What can you do to enforce a health intervention, describe it…

Answer 11

• Health needs assessment = systematic method for reviewing health issues facing a population. Leads to agreed priorities for resource allocation and hopefully reduce inequality and improve health.
• Cycle of needs assessment –> planning –> implementation —> evaluation –> back to assessment.
• Epidemiological, comparative, corporate.

Question 12

Calculation for point prevalence

Answer 12

Number of cases in population / population number

Question 13

How to compare incidence?

Answer 13

Looks at relative risk. Ratio of incidence in the 2 groups of people.
Calculation = risk of non-smokers / risk of smokers.
If it is >1 = risk factor.

Question 14

Odds ratio

Answer 14

Ratio of odds of a disease around exposed group and the odds of the disease among the unexposed group.

Question 15

Number needed to treat

Answer 15

1/ Attributable risk.

Attributable risk = risk in smokers / risk in non-smokers X 100.

Question 16

Calculation and definition of:

1. Specificity?
2. Sensitivity?
3. PPV?
4. NPV?

Answer 16

1. number of true negatives / all those in actually don’t have disease. (TN/(FP+TN))
2. number of true positives / everyone who actually has disease. (TP/ (TP+FN))
3. = TP / (TP + FP)
4. = TN / (FN + TN)

Question 17

What can associated be due to?

Answer 17

Bias - publication, information, selection.
Chance
Confounding
Reverse causality
True association

Question 18

Lead and length time bias

Answer 18

Lead time = early identification doesn’t alter outcome but improves survival.
Length time = Disease progress more slowly so unlikely to be picked up as asymptomatic but if they are screened for it appears screening prolongs life.

Question 19

4 needs

Answer 19

Felt (individuals perception of variation of health from norm)
Expressed (individual seeks to remedy variation)
Normative (professionally defined intervention for expressed need)
Comparative (comparison in severity, cost)

Question 20

Models for funding healthcare

Answer 20

Publicly - taxation, free to patients, e.g. UK.
Social insurance - compulsory sickness funds, e.g. France.
Privately funded - providers are private companies, e.g. USA.

Question 21

How to measure burden of disease?

Answer 21

Quality adjusted life years = sum of years spent in health state / utility score of quality.
Disability-adjusted life years = sum of years of life lost from premature mortality / years lived in disability.

Question 22

What is a cohort trial and what are some pros and cons

Answer 22

Data is obtained after the population have already been exposed to variables.
Pros: no allocation needed, ethically safe, can look at timings of exposure too.
Cons: confounders, unable to blind.

Question 23

Crossover trial

Answer 23

Group 1 takes medicine for 1 week, then 2nd week has alternative intervention.
Group 2 takes alternative intervention for 1 week, then 2nd week takes medicine.