pharm econ

  1. steps of the outcomes research process
    • identify
    • measure
    • value
    • compare
  2. steps of outcomes research taxonomy
    • data collection & data estimation methods
    • PE method; CA,CEA,CUA,CBA
    • PE & quality of life research
    • outcomes research
  3. technical efficiency
    when the maximum possible outputs are produced (over time) from a given set of inputs
  4. allocative efficiency
    when inputs are put to their best possible use so that no further gains are possible
  5. what analysis is used when dealing with allocative efficiency
  6. what analysis is used when dealing with technical efficiency
    • CEA
    • CUA
  7. 5 process' that are assisted with PE
    • budget planning
    • pricing decisions
    • formulary decision making
    • evaluation of clinical treatment guidelines
    • evaluation of pharmaceutical care services
  8. what are the outcome measurement units in CBA
    monetary units
  9. what are the outcome measurement units in CEA
    natural units
  10. what are the outcome measurement units in CMA
    assumed to be equivalent in comparable groups
  11. what are the outcome measurement units in CUA
    Quality-adjusted life years or other utilities
  12. cost-consequence analysis
    lists the costs and outcomes associated with each Tx
  13. cost of illness study
    attempts to determine the monetary burden of a particular disease or condition on society as a whole
  14. direct medical resources
    • medications
    • hospital days
    • tests
  15. other direct (non-medical) resources
    • input into treatment
    • other pt expenses
  16. indirect resources
    • unpaid assistance
    • days lost from work
    • decreased productivity
  17. intangible resources
    • pain
    • suffering
    • anxiety
  18. marginal cost
    the cost to produce one more unit of outcome
  19. total cost
    sum of all health care expenditures for entire population
  20. average cost
    total cost of treatment / total # of pts treated
  21. 5 process' for cost determination
    • specify inputs
    • count the units
    • assign dollar values
    • adjusting for differences in the timing of cost
    • allow for uncertainty
  22. specifying the inputs
    • payer
    • pt
    • provider
    • societal
  23. counting units
    • hospital days
    • single lab test
    • 30 day supply of medication
  24. primary data
    • clinical trials
    • naturalistic trial/ observation cost/ accounting system
  25. secondary data
    • administrative/ claims database
    • literature/ published AWP
    • expert opinion
  26. model data
    • decision analytical
    • statistical
  27. discounting equation
    • sum F / (1+ r)t
    • F - future cost
    • r - discount rate 5%
    • t - number of years from present time
  28. sensitivity analysis
    technique of systematically varying key variables in an analysis to determine if the results of the analysis change
  29. direct costs
    expenditures on tangible products or services, which contribute to the gross national product
  30. direct benefits
    measurable positive economic, clinical & humanistic outcomes that result from these products or services
  31. indirect costs
    include unpaid resource commitments and the cost of morbidity and mortality
  32. indirect benefits
    benefits derived rom avoiding indirect costs
  33. intangible costs
    costs of pain and suffering and take into account the preferences of patients/society
  34. intangible benefits
    benefits derived from avoiding the pain and suffering
  35. human capital approach
    • if medical care is seen as an investment in productivity
    • value intervention using earning potential
  36. revealed preference approach
    value intervention/life based on wage differences between jobs with different levels of risk
  37. willingness to pay / contingent valuation
    value intervention based on preferences
  38. cost analysis
    • compares the cost of 2 or more alternatives
    • use direct & indirect costs NOT outcomes
    • useful for budget considerations
  39. break even equation
    sum (fixed costs) + (#of units (sum(variable cost/unit) = (# of units)x(price)
  40. cost calculation of a CA
    (direct + indirect costs) - (direct + indirect cost savings)
  41. cost calculations of CBA
    (direct costs + indirect costs + intangible costs)
  42. when are modes used
    to study a phenomena when complete data are lacking
  43. decision analysis breaks down decisions into what
    • alternatives
    • probabilities
    • outcomes
  44. types of decision analytic models
    • decision tree
    • markov model
    • they are deterministic models because they account for 100% of the variation of the subjects being modeled
  45. what type of relationship is used in a decision analytical model
    functional relationship - for every level o X there is only one value for Y
  46. types of nodes in a decision tree
    • decision node = square
    • chance node = circle
    • terminal nodes = triangle
  47. 6 recommendations of decision tree construction
    • tree must have balance
    • only 2 branches after each chance node
    • no embedded decision nodes
    • the branches must be linked
    • the tree must have symmetry
    • the order of the branches does not matter
  48. example of when a CEA would be used
    • to determine which alternative provides the most benefit for a given dollar amount
    • or
    • to determine which alternative can produce the desired benefit or effect at the lowest cost
  49. measuring costs equation for CEA
    (direct costs + indirect costs) - (direct + indirect costs savings)
  50. how do you determine the cost/outcome in a CEA
    • identifying and measuring outcomes
    • valuing inputs
  51. what does an ICER show
    how much cost is increased when the marginally better treatment option is chosen for one patient
  52. criteria for ICER pt groups
    • mutually exclusive treatments alternatives
    • not between independent treatment alternatives in different pt groups
  53. formula for ICER's
    change in cost / change in effectiveness
  54. what makes a treatment dominated
    less effective and more costly
  55. what is extended dominance
    • a Tx has a higher ICER than a more effective Tx alternative
    • effectiveness is produced at a higher marginal cost than necessary
  56. 2 methods of prospective data collection
    • TTO - time trade off
    • SG - standard gamble
  57. when would you do a cost minimization analysis (CMA)
    when you have 2 treatments and the total effects are equal
  58. models for decision analysis
    • decision tree
    • markov model
  59. modesl for statistical analysis
    regression model
  60. how does a CUA work
    it converts the effectiveness data to a common unit of measure, mortality or morbidity
  61. if you are going to capture naturalistic outcomes what model do you use
  62. what model would you use if the effectiveness data indicate that alternatives are equal
  63. definition of utility
    the level of subjective satisfaction, distress, or desirability that people associate with a particular health state
  64. 3 ways utility are determined
    • judgement - educated estimates
    • literature - published estimates
    • measurement - prospective data collection
  65. When you are doing standard gamble what is the point where you decide to do the treatment even at the expense of the risk
    ambivalent point
  66. what is rater in a TTO model
    when a pt has knowledge of experience with the illness and it may influence their judgement
  67. cost calculations for CEA
    direct costs - direct cost savings
  68. cost calculations for CUA
    direct costs - direct cost savings
  69. what type of benefit/outcome is associated with cost analysis
    no outcomes measured, pick the cheapest product
  70. what type of benefit/outcome is associated with CEA
    natural units (life years gained, mm Hg blood pressure, mMol/L blood glucose)
  71. what type of benefit/outcome is associated with CMA
    assumed to equivalent in comparable groups
  72. what type of benefit/outcome is associated with CBA
    dollars or monetary units
  73. what type of benefit/outcome is associated with CUA
    quality adjusted life year
  74. what are the aspects of health related quality of life
    • physiological status
    • functional status
    • well being
    • life satisfaction
  75. what are the aspects of health status
    • physiologic status
    • functional status
    • well being
  76. what are the aspects of functional status
    • physical
    • mental
    • social
  77. 4 quality of life measures
    • utility measures (SG, TTO)
    • health profiles (SF 36)
    • functional indices (index of ADL)
    • disease specific measures (arthritis impact scale)
  78. difference between generic and disease specific measurements
    • generic has  the ability to make comparisons between conditions
    • disease specific has increased sensitivity
  79. reliability of a model
    • similarity of results provided by independent, but comparable measures of the same object.
    • consistency
    • a model can be reliable but not valid
  80. validity of a model
    • does the score measure what it is intended to measure
    • accuracy
  81. responsiveness of a model
    sensitivity to clinical changes in disease over time
  82. how do researchers minimize bias in PE models
    • include all key characteristics of the intervention being modeled
    • balance thoroughness with simplicity
    • be transparent
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pharm econ
pharm econ