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Define cost benefit

Costs and benefits expressed in monetary units


Define cost minimisation

Compares costs of alternative treatments of equal effectiveness


Define cost consequence

Costs expressed in monetary units and consequences in natural units e.g. deaths or time to relief of pain


Define cost effectiveness

Ratio of cost in monetary units and consequences in natural units e.g. death or time to pain relief –e.g. cost/minute of pain avoided


Define cost utility

Ratio of costs in monetary units and overall measure of health status (well being/utility) e.g. EQ-5D, SF-6D


Which model of health economics is preferred by nice and why?

Cost utility
Allows comparison between treatments for different disorders
Cost per Quality Adjusted Life Year (QALY), Incremental cost effectiveness/utility ratio
Cost in monetary units of buying one year of life in perfect health


What is health utility? And how do we measure it?

Measure of current overall health status
Can be measured in different ways
Within RCTs EuroQol-5D is brand leader: Self-completed questionnaire; preferred by NICE


What are the 5 dimensions of health utility?

Usual Activities
Pain / discomfort
Anxiety / Depression


What are direct and indirect costs?

Direct (NHS perspective): Cost used to deliver intervention (drugs, doctors, AHPs, transport, buildings)
Indirect costs (societal perspective): Lost productivity
Indirect costs (personal social care perspective): patient costs, social care costs


What is the Incremental Cost Effectiveness Ratio?

Cost / utility (QALYs)


What is proportional equality?

Equals should be treated equally and unequals unequally in proportion to the morally relevant difference


What is proportionate universalism?

Tackling social gradient in health requires a combination of both universal (population-wide) and targeted interventions that reflect the level of disadvantage and hence, the level of need


What is health inequality?

Differences in health experience and health outcomes between different population groups –according to socioeconomic status, geographical area, age, disability, gender or ethnic group


What is health inequity?

Differences in opportunity for different population groups which result in unequal life chances, access to health services, nutritious food, adequate housing etc. These can lead to health inequalities


What ethical principles are relevant in resource allocation in healthcare?

Maximising overall benefit (utilitarianism)
Prudence (managing public resources responsibly)
Respect for autonomy: Facilitating choice within prescribed options, Public involvement in decision making processes
Fair process: Consistency of reasons, Transparency, Opportunity for appeal/review


What is self management?

Individual’s ability to manage symptoms, treatment, physical and psychosocial consequences and life style changes inherent in living with a chronic condition
Efficacious self-management: ability to monitor one’s condition and to effect cognitive, behavioural and emotional responses necessary to maintain a satisfactory quality of life. Dynamic and continuous
process of self-regulation is established


What is self care?

Preventative strategy i.e. tasks performed by healthy people at home


What is self management support?

Portfolio of techniques and tools that help patients choose healthy behaviours
Fundamental transformation of patient-caregiver relationship into a collaborative partnership


Why is self management important?

Global burden of disease is growing
Long-term conditions are increasing as leading causes of
mortality worldwide: E.g. cardiovascular disease and diabetes
People with LTCs likely to spend


What do people with long term conditions want from healthcare?

To be involved in decisions about their care
To be listened to
Access to information to help them make those decisions
Support to understand their condition and confidence to manage
Joined up, seamless services and proactive care
Do not want to be in hospital unless it is absolutely necessary and then only as part of a planned approach
They want to be treated as a whole person and for the NHS to act as one team


What type of self management approach works best?

Active support works best, focused on self-efficacy (confidence) and behaviour to improve outcomes
Approaches that focus on whether people are ready to change
Information and knowledge alone are not enough


Describe the bandura model of self efficacy

Person -> efficacy expectations -> behaviour -> outcome expectations -> outcomes


What do efficacy expectations predict?

Whether individual is likely to engage in an activity or behaviour
The degree to which they will overcome obstacles
Likelihood of success in achieving and maintaining behaviour change


What do outcome expectations predict?

Whether performing specified task will have required effect


How can you enhance a persons self efficacy?

Positive mastery experiences
Positive vicarious experiences
Positive verbal persuasion
Positive emotional readjustment


What are key psychological components to positive emotional readjustment?

Finding and maintaining hope: believing in themselves, sense of personal agency, optimistic about the future
Re-establishment of positive identity: new identity which incorporates illness, but retains a core, positive sense of self
Building a meaningful life: making sense of illness, finding a meaning in life, despite illness engaged in life
Taking responsibility and control: feeling in control of illness and in control of life


What are the 3 enablers to positive emotional emotional readjustment and effective self management?

Agenda setting: Identifying issues and problems, Preparing in advance, Agreeing a joint agenda
Goal setting: Small and achievable goals, Builds confidence and momentum
Goal follow-up: Proactive: instigated by the system, Soon (within 14 days), Encouragement/ reinforcement


What is a SMARTER goal?



What are potential barriers to effective self management?

Behavioural beliefs (pain requires rest)
Subjective beliefs (its inevitable at my age)
Control beliefs and Self-efficacy (I can’t do anything to improve it)
Depression, weight problems, difficulty exercising, fatigue, poor physician communication, low family support, pain, and financial problems


What is the LTC 6 questionnaire?

Asks about long term condition patients health over previous 12 months. Questions are:
Did you discuss what was most important for you in managing your own health?
Were you involved as much as you wanted to be in decisions about your care or treatment?
How would you describe the amount of information you received to help you manage your health?
Have you had enough support from your health (and social care) team to manage your health?
Do you think the care and support you receive is joined up and working for you?
How confident are you that you can manage your own health?