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Pharmacoeconomics final part 1
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Terms in this set (62)
Two methods of estimating indirect costs:
Human capitol approach and Willingness to pay
Four types of costs
Direct medical, Direct non-medical, Indirect, and Intangible
A dollar today is worth _______ than a dollar tomorrow
more
When standardizing costs, you account for inflation when moving from _______ to present, and you discount when moving from ______ to present.
past, future
A discount factor is dependent on two variables ________ & __________.
Number of years into future (t) and discount rate (r)
Discount factor equation =
Discount factor = 1/(1+r)^t
Type of cost ratio that reflects the cost per outcome of one alternative independent of other alternatives:
Average cost ratio
Type of cost ratio that reflects the change in costs and health benefits from a one unit expansion or contraction of service from a particular intervention:
Marginal cost ratio
Type of cost ratio that represents the change in costs and health benefits when one intervention is compared to an alternative one:
Incremental cost ratio
Incremental cost-effectiveness ratio (ICER) equation:
ICER = (C2-C1)/(E2-E1)
Four examples of internal data sources:
Claims data, EMRs, chart abstractions, patient surveys
Two examples of external data sources:
Literature and publically-available databases
What is the most frequently used data source?
Literature
Which type of study translates health effects of diseases and injuries into dollar terms?
Cost of Illness (COI) study
Which approach to COI analysis estimates the cost of an illness to all individuals affected with the illness during a specified time period (usually 1 year)?
Prevalence-based approach
What is the most common approach to COI analysis?
Prevalence-based approach
Which type of COI analysis is good for evaluating treatment of short-term illness (like the flu)?
Prevalence-based approach
Which approach to COI analysis estimates the total cost of the illness from beginning to end (from diagnosis to cure or death)?
Incidence-based approach
Which type of COI analysis is best for policy-making decisions?
Incidence-based approach
Which type of COI analysis is best for estimating efficacy of chronic disease treatment?
Incidence-based approach
Which type of analysis compares all relevant costs and consequences of two or more therapeutic interventions with demonstrated equivalent outcomes?
Cost-Minimization Analysis (CMA)
What is the requirement for a CMA?
All outcomes must be equivalent
Which type of analysis is useful for comparing brand and generic products?
CMA
Which type of analysis is useful when comparing costs between different routes of administration of the same drug?
CMA
Which type of analysis is useful to compare different settings of administration of the same drug therapy?
CMA
Which type of analysis is useful when comparing one abx over another abx therapy when both have the same cure rate and side effect profile?
CMA
Which two scenarios can a CMA be used for?
Must have 2 or more interventions, and we want to know which intervention is least expensive
Which type of analysis is good for advocacy?
COI
Which type of analysis useful for priority settings (research and funding)?
COI
Which type of analysis is useful to establish disease burden for subsequent analysis?
COI
Which type of analysis is useful for citations?
COI
Which type of analysis assesses whether outcomes (benefits) of a program or intervention outweigh the costs?
Cost-benefit analysis (CBA)
What makes CBA's unique?
Both the costs and outcomes are measured in monetary terms
In a CBA, net benefit is _______ or net cost is ______.
>/= 0 or < 0
Benefit-to-cost ratios should be ________ and Cost-to-benefit ratios should be _______.
>/= 0 and < 1
Which type of analysis compares costs measured via resources consumed in monetary terms and benefits measured in natural units?
Cost Effectiveness Analysis (CEA)
What are four measures of natural units?
Clinical outcomes, life-years gained (LYG), life-years saved (LYS), and episodes avoided
_______ answers the question "can a drug work in a controlled setting", ________ answers the questions "does a drug work in the real world"
Efficacy, Effectiveness
Efficacy = ______, Effectiveness = ________.
Can, Does
Which type of analysis compares treatments when it is impossible or inappropriate to use monetary terms?
CEA
What must you determine to evaluate alternatives with CEAs?
Cost-effectiveness threshold
What are two broad ways CEA results can be presented?
Mathematically and graphically
What are 3 mathematical ways to present CEA results?
Statement of costs/consequences with no ratios, average CE ratio, incremental CE ratio
What are 3 graphical ways to present CEA results?
Cost-effectiveness plane, economic efficiency frontier, and cost-effectiveness acceptability curve (CEAC)
What are 4 aspects of CEAs that are subject to uncertainty?
Estimation of effectiveness, course of illness, HRQL consequences and preferences, and health care utilization and costs
What must be done for all CEAs to correct for uncertainty?
Univariate sensitivity analysis
Univariate sensitivity analysis' _________ the overall uncertainty in the CE ratio.
Understate
What second analysis should be done in CEAs when estimation errors in key parameters are thought to be correlated?
Multivariate sensitivity analysis
What are two limitations to presenting CEAs mathematically?
Point estimates may nor characterize overall distribution of cost-effectiveness values and simple CE ratios show average so they may not reflect variability in data
What are limitations to graphically presenting CEA data?
Same as mathematical limits plus difficult to interpret without defining a threshold value for cost-effectiveness
__________ provide a subjective means to interpret cost-effectiveness ratios.
Thresholds
US values for thresholds typically range from ______-_______/QALY
$50-100k
What three things may cause thresholds to vary?
Perspective, value placed on health/risk aversion, resources available
What does a tornado diagram present?
Univariate analysis' of CEAs
What is employed to evaluate variability across multiple variables at the same time?
Simulation methods
What are the two common approaches of simulation methods?
Monte Carlo and Boot-strapping
What provides insight into how similar/dissimilar CEA results are when resampling from a distribution of possible values?
Simulation methods
What are three reasons why you need confidence intervals for presenting simulation method results?
Incremental costs, incremental effectiveness, and joint distribution of the two
What type of graph plots the probability that the ICER is favorably cost-effective?
Cost-effectiveness acceptability curve (CEAC)
What is an alternative to calculating confidence intervals for ICERs?
Cost-effectiveness acceptability curve
What is useful to decision makers faced with the choice of whether or not to adopt a technology?
Cost-effectiveness acceptability curves (CEAC)
What provides a measure of uncertainty surrounding the choice, given a selected threshold?
Cost-effectiveness acceptability curves (CEAC)
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