77 terms

BCPS - Economic and patient reported outcomes

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Terms in this set (...)

Outcomes research
Research on measures of change in patient outcomes
Pharmacoeconomics
behavior or welfare of individuals, firms, markets relative to pharmaceutics, services and programs
Value
health outcomes per dollar spent
patient health outcome equals
clinical outcome plus quality of outcome plus satisfaction
Efficacy
degree to which an intervention works
cause and effect - clinical trials
Internal validity
Effectiveness
Degree to which intervention actually works in practice
real world
External validity
Efficiency
is the intervention worth the cost
ethics
should intervention be used regardless of cost
human worth
equity
Fair allocation of resources
ECHO Model
Economic, clinical, and humanistic outcomes
Overlapping model
ECHO Model - clinical outcomes
change in biomedical and physical events
decreased ESRD, MI, BP, A1c etc
ECHO Model - Economic outcomes
change in use of resources
fewer hospitalizations, ED visits, missed work days etc.
ECHO Model - Humanistic outcomes
change in patient status or QOL
increased social functioning, HRQOL, decreased pain (both clinical and humanistic)
Surrogate outcomes
decrease sample size, research time, clarify
may be in the continuum or a final endpoint
What type of outcome is decrease a in lumen diameter when considering MI
intermediary surrogate outcome
Is BP readings an intermediary surrogate outcome for heart attack?
No, Just has a positive association with MI
How may Adverse effects be used as surrogates?
for QOL or satisfaction
Cost
resources used
Opportunity cost
resources are finite, once used, it cannot be used for other reasons
Pareto Principle
80/20 rule
20% (high use segment) of population created opportunity costs carried by 80% of the population
Microcosting method of cost valuation
each item priced separately
time intensive to collect and have broad variation
Cost to charge ratio
divide total accounting cost by total billing amount
Multiply that by department's total billing amount
Aggregated method of cost valuation
average cost for the sum of individual items
Direct costs
only aspect included in gov't healthcare expenditure data
divided into medical(drugs, procedures, etc.) and non-medical (transportation etc.)
Indirect Costs
Costs of lost productivity caused by morbidity and mortality
absenteeism, presenteeism,
Human capital approach to indirect costs
accounts for wage variation
actual or estimated wages adjusted by lifespan
Willingness to pay
measures benefit of intervention based on the max people will pay for it
Intangible costs
effects of pain, decreased social role
Often not included in PE studies
Four categories of Perspective
society
payer
provider
patient
What is the preferred viewpoint for PE studies?
Societal
society perspective concerns
all types of costs
payer perspective concerns
direct medical and direct non-medical
insurance companies
Provider perspective concerns
Direct medical costs only
Patient perspective concerns
all costst
out of pocket, intangible, insurance premiums etc.
Piggy back study
RCT's rarely have economic outcome
Piggy backs run concurrently and evaluate costs
Limitations of piggy back study
not a real world... Exclusion and inclusion criteria etc
Randomized pragmatic study
Originally randomized but becomes observational
often has economic component
Modeling
common in PE studies
info from multiple sources, epidemiology, databases, EHR, creating a roadmap of disease being studies
Model based on probability of events occurring
Decision analysis
decision tree - visual roadmap to the range of outcomes
Each chance node equals 1
Only looks at linear progression
Markov Model
used for complex disease consideration
Allows for time consideration and ability to revert back to previous health (not linear)
mutually exclusive transient states that sequentially lead to a terminal outcome (death)
Bayesian Model
Similar to Markov - used when data elements are missing or inconclusive
Discrete event simulation model
no fixed time cycles or linear progression
Monte Carlo Technique - simulates infinite number of times from healthy population
Sensitivity analysis
unless all data elements come from same patient, costs and probabilities are estimates - sensitivity analysis tests the strength of the estimates
Univariate sensitivity analysis
one estimate at a time is changed while others held constant
tornado diagram created with the spread of evaluations
scenario sensitivity analysis
two or more estimates vary at a time
threshold sensitivity analysis
keep changing stuff until decision changes
analysis of extremes sensitivity analysis
worst case/best case
ends of CI for each estimate
When must discounting be done?
when cost and benefits occur over a period >1 year
Pharmacoeconomic evaluations
comparison of alternatives with at least one pharmacy product or service
Which component of the analysis is required for a full analysis?
outcomes must be measured and compared
Types of partial evaluation
cost analysis (list of costs)
cost of illness (assess burden of illness on society)
Do cost of illness studies measure effectiveness or efficiency of resources used?
No it is not a comparison between alternatives
Considers direct and indirect costs
What are the 4 types of full evaluations?
cost-benefit analysis
Cost-effectiveness analysis
Cost-utility analysis
Cost-minimization analysis
Which analysis measures costs and benefits in monetary units?
CBA
How do you choose an alternative over comparators in CBA?
Net gain to society (benefit exceeds cost)
How is valuation assigned in CBA?
Human capital and WTP approach
Ratio is sometimes used for output but magnitude in $ must also be reported
Which analysis measures costs and outcomes?
CEA
How is CEA presented?
monetary unites per unit of effectiveness
$/case cured, $/life year saved, etc
Disadvantage of CEA
only alternatives with the same outcome may be compared
What is an advantage of CEA
outcomes per dollar can be seen?
What analysis requires a worth or minimum (threshold) value to be selected?
CEA - In CBA, any positive value is acceptable
CUA - arbitrary cutoff also
ACER
average cost effectiveness ratios
total costs/total effectiveness
independent of other alternatives
ICER
incremental cost effectiveness ratio
cost intervention 1- cost intervention 2/
outcome 1 - outcome 2
Compares two options
Which analysis measures QOL?
cost utility in QALY gained
QALY
quality adjusted life year
quality of life x quantity of life
Biggest advantage of CUA?
can compare very different interventions
Standard gamble (utility determination)
only true measure of utility d/t including uncertainty
0 for death, 1 for full health
what probability of death would you trade for chance at full health
time trade off (utility determination)
how many years would you give up for health
rating scale (utility determination)
VAS
does not give a choice between two alternatives
bottom death ----------------------------top full health
Why is CMA not common?
Requires a situation where effectiveness and AE's are perferctly equivalent
no outcomes presented, only dollars
PRO
patient reported outcome
any report of status of patient's health directly from the patient with no interpretation
face validity
appearance of validity obtained by examing the questions
content validity
presence of items measuring the appropriate aspects
Construct validity
how well it reports what should be happening. should be similar to other tools
criterion validity
outcome compared with another way of measuring same construct
Known-group validity
can the tool make the discrimination between people with and without the state in question
3 purposes of instruments
1. discrimination between subjects
2. prediction of future outcomes
3. monitoring - measuring change