Phase 3B Health Economics Flashcards

1
Q

QALY calculation

A
  • Multiply the length of life (in years) expected to be gained by the new treatment or invention, by the quality of life a patient can expect to have.
  • Quality of life is measured on a 0 - 1 scale
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2
Q

QALYs.

a) The ‘Q’ in QALY - examples
b) Why are QALYs useful?

A

a) PROMs - preference-based or utility measures

b) They provide a common unit of benefit that allows comparison both within and between clinical area

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3
Q

Two methods to measure the value patients put on health

A

Time trade-off.
- Asks individuals how much time they would be willing to give up in order to avoid poor health states

The standard gamble.
- Asks individuals how much risk they are willing to take in order to avoid poor health states

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4
Q

Time trade-off:

a) Explain the method
b) explain how a health state might be valued as 0.6 (scale 0 - 1)

A

a) A method of valuing health states that involves giving up or trading life years for a better quality of life or to avoid poor quality of life.
b) An individual would equate 6 years of full health to 10 years of health at this state (6/10 = 0.6)

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5
Q

Economic evaluation.

a) Define

A

a) A comparison of the costs and benefits of two or more (healthcare) interventions

An economic evaluation always involve a comparison of at least two alternatives and that the comparison is made with respect to both costs and benefits. If a study does not meet both these criteria, then it is not an economic evaluation

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6
Q

Quality healthcare is… (STEEEP)

A
Safe
Timely
Efficient
Equitable
Effective
Patient-centred
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7
Q

Health economics evaluation of disability.

A

Disability-adjusted life years (DALYs)

0 = year of perfect health

(the higher the number, the worse the disability)

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8
Q

Equity and efficiency.

a) Define equity
b) Define efficiency
c) Explain the trade-off

A

a) Fair distribution of resources
b) Allocation of resources between activities in such a way as to maximise benefit

c) Improving equity often leads to a loss in
efficiency (eg. funding more for expensive diseases that lead to fewer resources to spend elsewhere)

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9
Q

Opportunity cost.

A
  • To spend resources on one activity (eg. heart transplants) means a sacrifice in terms of a lost opportunity cost elsewhere
  • The opportunity cost of an activity is the sacrifice in
    terms of the benefits forgone from not allocating
    resources to next best activity
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10
Q

Effect of disease prevalence on:

  • Sensitivity and specificity
  • PPV and NPV
A
  • Sensitivity and specificity are fixed (Unaffected by prevalence)
  • PPV increases with prevalence; NPV decreases with prevalence

Note:

  • Sensitivity and specificity are what doctors care about, as they are a measure of how good a test is (at detecting patients with disease/excluding those without)
  • PPV and NPV are what PATIENTS care about (“If I get a positive result, what is the chance I have the disease”, and vice-versa)
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11
Q

Healthcare systems

A

Publicly-funded systems (eg. NHS)
- funded through taxation, publicly-owned services

Social insurance funded health systems (eg. Singapore, Germany)
- compulsory sickness funds for healthcare; separate providers contracted to provide services which are paid for by fund

Privately funded systems (eg. USA)

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12
Q

Types of economic evaluation

- Give the 4 types and their outcome measures

A

Cost-effectiveness analysis.
- outcome: incremental cost per life year gained

Cost-utility analysis.

  • utility outcomes (QALYs, DALYs)
  • eg. incremental cost per QALY gained

Cost-benefit analysis
- uses monetary outcomes

Cost-minimisation analysis
- outcomes known to be equal, just comparing costs (which is cheaper?)

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13
Q

Incremental cost-effectiveness ratio (ICER).

a) How to calculate
b) Units (in cost-effectiveness vs. cost utility analyses)
c) Funding thresholds for NICE
d) “Existing drug costs £10,000 and adds 5 QALYs; new drug costs £15,000 and adds 6 QALYs”
- What is the ICER?
e) Problems with ICER rule

A

(Cost of intervention A minus Cost of intervention B, in £) divided by (Benefit of A minus Benefit of B, in QALYs)

b) Cost (£) per life-year (CEA) or QALY (CUA) gained

c) NICE define threshold of ~ £20,000 per QALY gained
(if more expensive than this per QALY gained, it will likely not be funded)

d) (15,000 - 10,000) / (6 - 5)
= £5,000 per QALY gained

e) - Palliative treatments may not be funded due to lack of survival added
- Very rare diseases with expensive treatments will not be funded
- Patient choice not factored in; individual funding requests

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14
Q

ICER planes:

a) Dominant treatments
b) Dominated treatments
c) Other 2 options

A

a) Dominant interventions.
- Less costly (-ve incremental cost), and
- More effective (+ve incremental QALYs)
(should be funded)

b) Dominated interventions.
- More costly (+ve incremental cost, and
- Less effective (-ve incremental QALYs)
(should not be funded)

c) - More effective, but more effective
- Less costly, but less effective
(may or may not be funded)

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