Pharmacoeconomics > Exam > Flashcards

Exam Flashcards

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1
Q

What is the decision-tool to compare costs with consequences?

A

ECHO

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2
Q

What does ECHO stand for?

A

Economic (money)
Clinical (BP measures)
Humanistic consequences (outcomes/QOL)

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3
Q

“Can it work?” is an example of what?

A

Efficacy (phase II trials)

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4
Q

“Does it work?” is an example of what?

A

Effectiveness

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5
Q

“Is it reaching those who need it?” is an example of what?

A

Availability

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6
Q

What is properly allocating resources, lowest cost/unit of output?

A

Efficiency

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7
Q

What is pharmacoeconomics?

A

Economic evaluation of pharmacotherapy

Tool to identify, measure, and compare costs and outcomes of use of pharmaceutical products and services

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8
Q

What is the equation for value?

A

Value = Benefits/costs

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9
Q

What do healthcare providers mean by added value?

A

Cost-effectiveness

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10
Q

What do healthcare providers mean by what is it going to cost?

A

Budget impact

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11
Q

What is PEC?

A

Pharmacoeconomics

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12
Q

What are the essential elements of economic analyses?

A

Cost determinants
Measuring costs
Discounting costs
Sensitivity analysis

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13
Q

What are the three pieces that determine cost of therapy?

A

Identification
Measurement
Valuation

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14
Q

What is identification in determining cost of therapy?

A

All relevant resources consumed by intervention need to be identified

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15
Q

What is measurement in determining cost of therapy?

A

Magnitude of resource consumption, in numbers

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16
Q

What is valuation in determine cost of therapy?

A

Placing monetary value on quantified resource consumptions

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17
Q

What are tangible costs and benefits?

A

Direct medical costs/benefits
Direct non-medical costs/benefits
Indirect costs/benefits

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18
Q

What are intangible costs and benefits?

A

Unquantifiable costs and benefits

  • Improved health after treatment
  • Reduced pain
  • Pain and suffering associated with tx
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19
Q

What are direct medical costs?

A 
Medications
Medication monitoring
Medication administration
Pt counseling/consultations
Diagnostic tests
Hospitalizations
Clinic visits
ED visits
Home medical visits
Ambulance services
Nursing services
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20
Q

What are direct nonmedical costs?

A

Travel costs to receive health care
Nonmedical assistance related to condition (Meals-on-wheels, homemaking service)
Hotel stays for patient/family for out-of-town care
Child care services for children of patients

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21
Q

What are indirect costs?

A

Lost productivity for patient
Lost productivity for unpaid caregiver
Lost productivity b/c of premature mortality

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22
Q

What are intangible costs?

A

Pain and suffering
Fatigue
Anxiety

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23
Q

What is the Drummond classification of costs?

A

Health care sector costs
Other sector costs
Patient and family costs
Productivity costs

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24
Q

What are sources of cost?

A 
Payers
Third part vendors
Providers
Biomedical, biopharmaceutical and pharmaceutical companies
Patient and caregiver reported
Tertiary data sources
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25
Who are payers?
Managed care providers Pharmacy benefit managers Medicare Medicaid
26
Who are third party vendors?
Purchase proprietary data from variety of sources and aggregate Group purchasing organizations Management companies
27
Who are providers?
Health systems Individual providers Pharmacies, hospitals, etc
28
Who are tertiary data sources?
Micromedex contains Red Book Prices (AWP)
29
What are types of hospital costing?
Micro-costing Case-mix group Disease specific per diem (daily cost) Per diem
30
What is micro-costing?
Each component of resource used quantified, measured, valued
31
What is case-mix group?
Gives cost for each category of case/type of patient | Accounts for LOS
32
What is disease specific per diem?
Gives mean daily cost for treatment of certain diseases
33
What is per diem hospital costing?
Mean daily cost for all patients
34
Which type of costing is the most precise?
Micro-costing
35
An ambulance cost is what type of cost?
Direct medical cost
36
Improved health after treatment would be what type of cost?
Intangible
37
What is the main goal of tracking costs and outcomes?
Not to mislead policy maker
38
When do we use short-term tracking?
In hospital - to discharge
39
When do we use medium term tracking?
Payer - 1-5 years
40
When do we use long term tracking?
Patients - lifetime
41
What are the two types of differential timing costs?
Cost standardization-past costs to present | Discounting-future costs to present
42
What is a short term discounting cost?
< 1 yr, really no need
43
What is a longer-term tracking discounting cost?
1+ year
44
Why do we discount/standardize?
Inflation - $ today worth more dollar in future | People would rather have certain benefit today than one in future
45
What is the ISPOR equation for discounting?
``` PV = FC x DF (n,r) PV = present value FC = future costs DF = discount factor n = number of years r = discount rate ```
46
What are the types of PEC analysis?
Cost-minimization Cost-effectiveness Cost-benefit Cost-utility
47
What are the costs and outcomes of cost-minimization?
``` Costs = monetary units Outcomes = assumed to be equivalent ```
48
What are the costs and outcomes of cost-effectiveness
``` Costs = monetary units Outcomes = naturals units (life years saved) ```
49
What are the costs and outcomes of cost-benefit?
``` Costs = monetary units Outcomes = monetary units ```
50
What are the costs and outcomes of cost-utility?
``` Costs = monetary units Outcomes = Quality-adjusted life years ```
51
What is the most common type of PEC analysis?
Cost-effectiveness
52
When is a cost-effectiveness analysis used?
Limited budget and have range of options w/in a field
53
How must the outcomes compare in a cost-effectiveness analysis?
Outcome is same unit
54
What does a cost-effectiveness analysis compare?
Costs and consequences of two alternative treatments
55
What is the calculation for cost-effectiveness?
ICER (incremental cost-effectiveness ratio) (Cost1 - Cost2) / (Outcome1 - Outcome 2) 1 = new drug 2 = comparator
56
When are interventions said to be cost-effective?
Less expensive AND more effective Less expensive AND at least as effective More expensive AND more effective
57
What intervention is said to not be cost effective?
Higher cost and less effective
58
When is an ICER positive?
New tx more expensive AND more effective New tx less costly and less effective Generally want smaller ICER
59
When is an ICER negative?
New tx less costly and more effective | New tx more costly AND less effective
60
When are cost-effectiveness analysis most applicable?
Comparing costs/outcomes of 2+ alternative HTN med | Compare 2+ alternative programs to prevent mortality
61
What is a surrogate outcome?
Intermediate Easy to measure/obtain Needs to be related to hard outcome
62
In a CEA, what should be included in the methods?
Explicit description of costs/consequences Perspective analysis Methods and sources of data
63
What are limitations to ICER?
Relatively small positive ICER driven by small increase in cost OR large gain in effectiveness Conveys limited information to policy-makers
64
What do negative ICER scenarios represent?
New medication/service dominant OR New medication/service being dominated
65
What are the parts of QALY?
Life gained (mortality) AND Quality of that life gained (morbidity)
66
When should a cost-utility analysis be used?
When HRQOL is most/an important outcome When program/service affects mortality and morbidity and you want common unit to measure both When program/service have wide range of different kinds of outcomes and you want common unit of output for comparison Limited budget, policy-maker must determine which program/service to reduce/eliminate to free-up funding for new program/service Allocate limited resources optimally and using constrained optimization to maximize health gain achieved
67
What are problems with CUA?
Most difficult/ time-consuming/ expensive economic evaluation
68
How is QALY usually measured?
Years
69
What is the scale for QALY?
Anchored on scale from 0 (death) to 1 (perfect health) | Can be adjusted to reflect states worse than death (< 0)
70
What is the focus of QALY?
Health states
71
How is QALY calculated?
If utilities are same, then difference in QALYs is difference in AUC If utilities are different, then adjust to estimate incremental QALYs Life gained x utility
72
How do we obtain utility weights?
Utility is preference Through literature Direct measurement from patients/general public
73
What are the 3 methods for measuring utility?
Standard gamble (SG) Time trade-off (TTO) Visual analog scale (VAS)
74
A CUA is a type of what other analysis?
CEA
75
What is the SG based on?
Utility theory
76
How many alternatives are available in a standard gamble?
2
77
What is alternative 1 in a standard gamble?
Tx w/2 outcomes: - Returned to perfect health and lives for additional x years - Patient dies immediately
78
What is alternative 2 in a SG?
Certain outcome of chronic state i for life
79
How is SG probability manipulated?
Until subject indifferent b/t two alternatives which is preference score
Pharmacoeconomics
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