Terms in this set (29)
What are the 3 fundamental elements?
1. Scarcity - needs, wants and demands are greater than the resources available
2. Choosing - how scarce resources should be allocated
3. Alternative uses - Opportunity costs - by using resource in one way, other opportunities for using this resource are foregone
Want to maximise benefit and minimise opportunity cost
What is economic evaluation?
Comparative analysis of alternative courses of action in terms of both their costs and their consequences
Concerned with efficiency (value for money), not just effectiveness
What are the 2 types of efficiency?
1. Allocative - choosing which problem should have money spent on it
2. Technical - finding best way to treat people (same disease) with a FIXED BUDGET
Describe the incremental cost-effectiveness plane
The costs and benefits of relevant interventions, for a specific condition, are compared with each other. The new intervention is generally compared with current practice
What are the stages for designing an economic evaluation?
1. Design question and viewpoints
2. Select alternatives for comparison
3. Identify possible care pathways associated with the alternatives: important resource inputs and outcomes
4. Framework for the evaluation (Trials vs. Modelling) - determines effectiveness of alternatives
5. Measure and value input resources
6. Measure and value outcomes
7. Analyse data and compare alternatives in terms of expected costs and benefits
8. Characterise uncertainty
What are the 2 best methods of establishing effectiveness?
1. RCTs - gold standard
How can a trial be better suited to economic evaluation?
- Pragmatic design looking at effectiveness
- Long term follow-up
- Final health and QoL outcomes
- Multi-centre (generalisability)
Name some essentials that need to be done
- Extrapolate beyond follow up period
- Comparison of all alternatives
- Link intermediate endpoints to health outcomes
- Reflect all appropriate data
- Make results applicable to decision making context
Costing in economic evaluation (this is not really a question)
Need to IDENTIFY, MEASURE and VALUE the resource use
Need to consider the resource use associated with events and outcomes in the patient pathway
- initial treatment
- management of complications
- subsequent treatment
- all other resources associated with health outcomes (staff, related services, cost to patients and families, production losses)
What is productivity loss?
The value of time lost from work due to patient in treatment
For the initial procedure / intervention, how can resources be valued?
Case report forms, medical records / case notes
For the follow-up period, how can resources be valued?
Patient questionnaires, diaries, routine data collection systems
What are the two methods of estimating unit costs and how do they differ?
1. Top-down costs
- Divide total expenditure of given area by the number of patients treated
- Good for when data is scarce
2. Bottom-up costs
- Involves cost of all ingredients going into a patients treatment
What are the 3 types of economic evaluation and what are their outcome measures and valuation methods?
1. Cost effectiveness analysis (CEA)
- Natural units
2. Cost utility analysis (CUA)
- Health state descriptive systems
3. Cost benefit analysis (CBA)
- Monetary value
- WTP, DCEs
Describe cost effectiveness analysis
The effects are measured in appropriate uni-dimensional natural units.
- You are restricted to comparisons between alternatives with the same outcome (technical efficiency)
Describe cost utility analysis
The effects are measured in multi-dimensional units which combine effects on survival and quality of life
- Can inform judgments on both allocative and technical efficiency
What are QALYs?
Quality adjusted life years are quality weights that represent the relative desirability of health states on a scale from 0 (death) to 1 (full health) (can also be negative value). The concept combines life expectancy with QoL
They are assigned to represent health related QoL associated with health status under consideration (mobility, sensation, pain, cognition, emotion etc.)
What are some methods used for calculating QALYs?
1. Visual analogue scale
2. Time Trade Off (TTO)
3. Standard Gamble (SG)
What are health state descriptive systems?
Pre-scored multi-attribute health state classification systems, minimising time consumption and resource intensity (EuroQoL, SF-6D, Health Utilities index)
Describe Cost benefit analysis
A systematic process for comparing and calculating costs and benefits of interventions. Measured in commensurate units.
- Adopts a societal viewpoint
- Concerned with allocative efficiency
Disadvantage is that monetary assessment of clinical results must be made even though methodologically this is difficult to perform
What is WTP and payment vehicles?
Willingness to pay - when individuals are asked the maximum amount they would hypothetically pay for a service. It allows the individual to consider all characteristics of the commodity important to them
Payment vehicle is the manner in which WTP payment is to be made
- Out of pocket payments
- One off extra taxation payment
- Private insurance premia
- Voluntary donations
What are the advantages and disadvantages of WTP?
Advantages: Flexibility, allows more to be valued than simply improvements in health related quality of life
Disadvantages: difficult relating concept of paying for health care, difficult to assign monetary values of things which are considered by many to be incommensurate with money valuation
What do DCEs measure?
The extent to which an individual values a good or service depending on the levels of certain attributes
What things have to be considered in analysis and interpretation?
- Time frames - benefits may not appear for many years
- Time preference - positive time preference (individuals prefer to receive benefits now and incur costs later - short term view of life, future is uncertain, wealthier in the future)
- Adjusting for differential timing of costs and consequences
What is the name given to the additional cost of achieving an additional unit of benefit?
Incremental Cost effectiveness ratio (ICER)
How is ICER calculated?
Difference in cost divided by the difference in outcomes (for example QALYs)
How do you handle statistical uncertainty?
What is the crucial final step in economic evaluation?
Sensitivity analysis - Determines the robustness of your findings
What are the benefits of health care interventions?
Improvement in health