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99 Cards in this Set
- Front
- Back
Economic eval measures (5)
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1)COI (cost of illness)
2)CMA (cost minimization analysis) 3)CBA (cost benefit analysis) 4)CEA (cost effective analysis) 5)CUA (cost utility analysis) |
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Humanistic evaluations (4)
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1)QOL
2)patient preferences 3)pt satisfaction 4)WTP (willingness to pay) |
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Clinical evaluations (3)
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1)experimental
2)quasi-experimental 3)epidemiologic |
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Experimental eval (3)
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1)RCT
2)double blind 3)cross over |
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Epidemiologic eval (3)
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1)case control
2)cohort 3)field trial |
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Pharmacoeconomics/ECHO model has drawn from.... (5)
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1)economics
2)pharmacy 3)medicine 4)epidemiology 5)social sciences |
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Pharmacoeconomics concepts introduced...
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in 1979 by McGhan, Rowland, Bootman in AJHP
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Who and when decided dosing of AG's is beneficial
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1979 bootman
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Who and when introduced the term pharmacoeconomics
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1986 Townsend/Glaxo
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____ is linked to the success of pharmacoeconomics and outcomes research
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MTM/Pharmaceutical care
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ECHO?
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economic, clinical, humanistic outcomes
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ECHO clinical outcomes (3)
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1)medical event that occurs as a result of disease/treatment
2)measures pts physical and biomedical status 3)infers degree of disease |
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Factors affecting clinical outcomes are mainly....and 4 of em
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ECONOMIC
1)labs 2)rads 3)visits 4)hospitalizations |
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Economic outcomes in ECHO (4)
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1)total costs of medical care w/ treatment alternatives to achieve clinical and humanistic outcomes
2)medical 3)non-medical 4)productivity costs |
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Factors affecting economic outcomes (2)
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1)clinical and/or humanistic outcome
2)persepctive |
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ECHO Humanistic outcomes (3)
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1)CONSEQUENCES of disease or treatment on pt fxnal status or QOL
2)effectiveness and safety no longer only factors 3)effects of symptom relief and ADR's FROM PT PERSPECTIVE are MAIN CONCERN |
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ECHO humanistic important factors (5)
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1)lost productivity
2)ADR's 3)efficacy/effectiveness 4)WTP compliance 5)pt knowledge |
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Economic Analyses w/ ECHO characteristics (4)
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1)cost-containment does NOT mean improved pt care
2)critical to quantify the value of pharmaceutical products and services 3)pharmacoeconomics incorporates a complete evaluation of the COSTS AND CONSEQUENCES 4)requiress more than comparing acquistion costs |
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Def of
a)costs b)consequence via ECHO |
a)VALUE of ALL resources consumed by a service or treatment
b)Effect, outputs, and outcomes of the service or treatment |
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Direct Costs involves...(2) and 2 types
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1)resources consumed in the prevention, detection, or treatment of disease or illness
2)INVOLVES A TRANSFER OF MONEY 1)direct medical 2)direct non-medical |
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Direct medical costs (5)
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1)hospitalizations
2)drugs 3)labs 4)rads 5)ER, etc |
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Direct non-medical costs (2 and 3ex)
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1)costs of non-medical products that result from a disease/illness
2)do NOT involve purchase of medical P&S 3)transportation, family care, special food |
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Indirect Costs (1 and 4ex)
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1)costs resulting from morbidity and mortality (controversial)
2)UNPAID 3)lost productivity 4)missed work 5)cost of premature death |
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Intangible Costs (2 and 3ex)
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1)most difficult to measure
2)non-financial outcomes of disease and medical care 3)pain, suffering, grief 4)QUALY (quality adjusted life year) 5)WTP |
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Incremental Costs
a)desc (4) b)at some point... c)ex (2) |
1)As interventions incr in intensity, costs incr as well
2)additional outcome gained per additional dollar spent 3)additonal cost incurred by an alternative OVER ANOTHER UNLIKE alternative 4)extra costs reqd to achieve an additional outcome 1)at some point additional expenses to achieve additional outcome may become prohibitive 1)adding MRI vs. CAT Scan 2)Drug A vs. Drug B |
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Marginal Costs (2 and 1ex)
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1)additional cost incurred by and alternative OVER ANOTHER LIKE alternative
2)extra costs reqd to achieve an additional outcome 1)incr dose of same drug |
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Opportunity Costs (1 and 1ex)
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1)when resources consumed in a specific treatment; the ability to use those resources for other purposes is lost
1)adding PET scanner vs. an immunization program |
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Perspective desc (3 and 4ex and 1 special ex)
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1)is a viewpoint
2)inflence cost and consequences 3)single most important decision 4)4 types: payer, provider, pt, society Some can have several perspectives like gov't as payer and provider |
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Patient Perspective of
a)cost b)consequences |
1)OOP expenses (copay and so on) AND indirect costs by be important
2)clinical outcomes/effects |
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Provider Perspective (4)
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1)true expense of providing a product or service (NOT WHAT IS CHARGED)
2)difficult to ID 3)primarly are direct medical costs 4)useful for formulary decisions |
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Payer Perspective
a)ex (3) b)costs... c)desc |
1)insurers, gov't, employers
2)charges allowed or reimbursed 3)primarily direct medical costs but indirect costs may be important to employers |
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Important indirect costs from the payer/employer prospective (3)
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1)lost productivity
2)sick days 3)excess manpower |
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Societal Perspective
a)costs b)primary use c)CONTROVERSIAL SO... |
a)ALL relevant costs and outcomes
b)for public health issues c)becoming less dominate |
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2 Economic Evaluations
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Full (compare 2 ore more alternatives COST AND CONSEQUENCES)
Partial (only one alternative) |
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Efficacy(2) vs. effectiveness(3)
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Efficacy
a)derived from controlled clinical trials b)not reflective of real world Effectiveness a)effect of treatment in actual use b)real world use c)uncontrolled environment |
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UNITS of cost for COI, CMA, CBA, CEA, CUA
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DOLLARS
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OUTCOME units of
a)COI b)CMA c)CBA d)CEA e)CUA |
a)n/a
b)equivalency c)dollars d)clinical effects e)QUALY (quality extended life year) |
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Cost-of-illness
a)estimates... b)determines... |
a)estimates overall cost of a specific disease in a specific popultion w/ direct and indirect costs
b)determines relative value of treatment or prevention |
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Cost-of-illness other (3)
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1)not used to compare competing alternatives
2)provides evidence of the financial burden of disease 3)may also provide product and marketing strategy for drug companies |
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Cost-minimization analysis
a)compares... b)determines... c)ex (2) |
a)2 or more alternatives that are considered =
b)determines the least costly alternative (minimizing costs) c)brand v. generic, therapeutic equivalents |
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Cost Benefit analysis
a)units b)presented in...(2) c)looks @... d)___ must be EFFICIENT |
a)cost and outcomes in $
b1)benefit cost ratio b2)net benefit (most common) c)ALL relevant costs/outcomes d)largest net benefit alternative |
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You can compare completely different alternatives via...
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CBA**, CEA
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CBA is useful for...(3)
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1)benefits can be monetarily expressed
2)differing outcomes 3)pharmaceutical services |
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Cost-effectiveness analysis basic stuff (4)
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1)most common and most misused (likely to be banned from publication)
2)alternatives NOT therapeutically equivalent 3)cost in $ 4)effect in natural units (alternatives must be measured in same natural units) |
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Natural units ex (2)
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1)life year gained
2)pregnancies avoided |
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Cost-effectiveness analysis
a)cost-effective vs. cost savings (2) b)cost effective situations (3) |
a1)cost saving: Least costly
a2)cost-effective: cost optimization b1)less expensive and at least as effective b2)more expensive and more effective b3)less expensive and less effective |
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CEA
a)average Cost-effectiveness Ratio (2) |
1)average cost of achieveing a specific effect
2)total cost of A / Total effects of A |
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CEA
a)incremental cost-effectiveness ratio (3) |
a)cost per unit of effect achieved by switching from one treatment alt. to another
b)cost to achieve an additional successful outcome w/ a competing alternative c)total cost of A - total cost of B / total effect of A - total effect of B |
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CEA's
a)not appropriate to... b)compared via... c)useful to compare... |
a)DIRECTLY COMPARE CEAs
B)INCREMENTAL RATIOS c)competing alternatives w/ same effect |
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Discounting
a)adjust for.. b)based on... c)used when... |
a)DIFFERENTIAL TIMING
b)principle that ppl would rather have $ and/or benefit today rather than in the future c)effects and costs accrue over multiple years or different time periods |
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Discounting also.... (3)
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1)provides a common ground for comparison
2)discounts should be varied 3)5% most commonly used |
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Sensitivity analysis desc (5)
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1)NO statistical analysis involved w/ this
2)manages uncertainty 3)tests sensitivity of the analysis to the assumptions made 4)test ROBUSTNESS OF results 5)assumptions or sensitive variables are varied over a range of reasonable values |
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Sensitivity analysis
a)Vary key variables in the decision process (3) b)4 types |
a1)assumptions
a2)high cost values a3)clinical effects b1,2,3)one-way, two-way, three-way b4)threshold analysis |
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Decision analysis (3)
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1)structure the logical and chronological order of the analysis
2)decision tree provides graphic representation 3)CEA is calculated for this |
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Incrmental Cost Analysis (2)
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1)similar to incremental CEA
2)BUT only costs included in the analysis |
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Applications of all these different economic analysis's (2)
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1)efficient use of scarce resources
2)rational decision making by HC policy makers |
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Formulary Management decisions require more than just...(3) and...
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1)safety
2)efficacy 3)cost 1)many use economic analysis to assist in formulary decisions |
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Economic Analysis in formulary management via...(4)
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1)inclusion/exclusion of drugs
2)restriction of drugs 3)deletion of drugs 4)influence prescribing patterns |
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Economic Analysis in Practice/Clinical guides (5)
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1)standardize medical care provided
2)eliminate variation 3)allow most efficient use of resources 4)increasingly popular in MCO's 5)provides algorith for treatment of average pt w/ specific disease |
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Economic analysis in drug use policy (3)
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1)influence MD prescribing
2)allows efficient use of drugs 3)policy success directly linked to pharmacoeconomic data |
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Economic analysis in service/program eval (5)
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1)determine value of existing or proposed pharmacy service
2)widely used in: a)ambulatory care b)LTC c)kinetics d)clinical pharmacists |
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Economic analysis in individual pt treatment (2)
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1)most methods eval pt groups
2)methods can be applied to individual pts |
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QOL/HQL? (4)
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1)eval of all aspects of life
2)Health-related QOL (HQL) considers aspects of life centered around health 3)utilize standardized questionairres 4)HQL is one of 12 QOL domains |
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Evaluating quality of care (4)
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1)first determine what is quality of care
2)structure 3)process 4)outcome |
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History of HQL has a ___ focus...(3)
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MULTIDIMENSIONAL
a)physical b)psychological c)social |
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General measurement instruments
a)fxn b)multidimensional ex's (4) |
a)emphasize the negative/lower end of the health spectrum
b1)physical fxning b2)social and role fxning b3)mental health b4)health perceptions |
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Physical fxning is measured via... (4)
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1)limitations experienced over a defined period
2)physical abilities 3)days in bed 4)bodily pain |
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Social and Role fxning is measured via...
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Social)extent of participation in social interaxns
Role)duties and responsibilties that are limited by health |
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Mental health measured via... (3)
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1)psychological aspects of health
2)NOT diagnostic tools 3)frequency and intensity of symptoms |
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General Health Perceptions measured by... (3)
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1)overall beliefs or evaluations of health
2)help compensate for individual differences/preferences 3)question current health and health outlook |
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General Health measurement instruments
a)adv (2) b)disadv (1) |
a1)assess relative burden of different conditions
a2)any age, ethnicity, gender b1)do not cover specific areas or specific diseases |
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Disease-specific measurement instruments (4)
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1)more narrowly focused
2)info concerning the impact of a disease and its treatment FROM A PTS PERSPECTIVE 3)used in conjunction w/ general instruments 4)MAKE SURE THEY ARE VERY SENSITIVE TO CHANGES IN QOL |
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Thing about QOL reading...
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MUST USE MULTIPLE MEASUREMENTS, ONE TIME MEANS NOTHING
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Psychometric considerations
a)def b)instrument must be...(3) |
a)science of testing using questionairres to measure attributes of ppl
b1)reliable b2)valid b3)sensitive to change |
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Pt Satifaction measurements
a)general (1) b)must cover...(3) |
1)developed for SPECIFIC settings
a1)accessibility and continuity of care a2)comprehensiveness of care a3)integration of care |
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CEA has been used since…
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1960s
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CEA is important for…. (2) (COST EFFECTIVENESS ANALYSIS)
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1)important for rational decision making regarding limited resources and almost unlimited demand
2)maximize resources and outcomes |
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How to conduct a CEA (COST EFFECTIVENESS ANALYSIS)
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No single widely accepted method for conducting CEA
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Why no single method for doing a CEA (due to variations in...) (5) (COST EFFECTIVENESS ANALYSIS)
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1)populations
2)settings 3)disease 4)treatments 5)lack of time, data, $ |
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CEA goal, and units of cost/outcomes (COST EFFECTIVENESS ANALYSIS)
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G)ID, examine, and compare the COSTS AND CONSEQUENCES of competing treatment alternatives
Cost in dollars Consequences/outcomes in natural u |
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CEA is used to…. (COST EFFECTIVENESS ANALYSIS)
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Assess whether outcome is worth cost
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CEA 3 types of results and are dependent on…. (COST EFFECTIVENESS ANALYSIS)
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1)less expensive and at least as effective
2)more expensive and more effective 3)less expensive and less effective Value placed on a health outcome relative to cost |
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CEA does NOT…. (COST EFFECTIVENESS ANALYSIS)
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Monetarily value life or outcomes, they are identified by clinical objectives
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Name of CEA resultant and 3ex (COST EFFECTIVENESS ANALYSIS)
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COST-EFFECTIVENESS (CE) RATIO
1)cost per case cured 2)cost per death avoided 3)cost per mmHg blood pressure decreased |
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CEA allows for rational decision making via…. (2) (COST EFFECTIVENESS ANALYSIS)
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1)lowest cost therapy NOT necessarily the most cost-effective
2)most effective therapy NOT necessarily most cost-effective |
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CEA alternatives must…. (COST EFFECTIVENESS ANALYSIS)
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HAVE SAME CLINICAL OUTCOMES, cannot compare 2 alternatives w/ different effect (BIG LIMITATION)
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CEA cautions (when looking at one) (2) (COST EFFECTIVENESS ANALYSIS)
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1)often used when only costs are compared
2)often used in place of CMA |
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3 things on defining the problem in CEA (COST EFFECTIVENESS ANALYSIS)
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1)clearly define it
2)must be specific and descriptive (should include time frame too) 3)include perspective**** |
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In identifying TREATMENT ALT in CEA you must….(7) (COST EFFECTIVENESS ANALYSIS)
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1)review all relevant articles
2)including primary/secondary articles 3)can also include Meta-analysis (combined results of multiple studies) 4)distinguish b/w EFFICACY AND EFFECTIVENESS 5)ID adr’s and treatment paths 6)Establish all significant ECHO outcomes 7)primary outcomes are most desirable (like hct, or HgA1c) |
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____ studies require the most ppl
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ECONOMIC (more than clinical even)
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Research design for CEA (experimental) (COST EFFECTIVENESS ANALYSIS) (4)
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1)piggy-backing
2)economic clinical trial or naturalistic trial 3)observational 4)simulations (modeling) |
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CEA piggy backing (5) (COST EFFECTIVENESS ANALYSIS)
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1)collection of economic data while conducting a RTC
2)rigorous 3)too controlled 4)does NOT reflect real world 5)generalizability narrowed due to inclusion/exclusion criteria |
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CEA economic clinical trial (or naturalistic trial) (COST EFFECTIVENESS ANALYSIS) (6)
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1)BEST DESIGN FOR CEA
2)pts treated in natural setting 3)gives more accurate picture of real world 4)PROVIDES EFFECTIVENESS DATA 5)expensive b/c large sample size |
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CEA observational (COST EFFECTIVENESS ANALYSIS)
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claims data analysis
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CEA simulations (modeling) (COST EFFECTIVENESS ANALYSIS) (3)
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1)inexpensive
2)combines data from medical lit, CT, meta-analysis, opinions 3)uses computer based visualzation decision tree |
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Identifying and measuring outcomes for CEA (COST EFFECTIVENESS ANALYSIS) (3)
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1)narrow scope of analysis for practicality reasons
2)only include significant and relevant outcomes 3)perspective must align w/ ALL outcomes |
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Measuring and Valuing Costs and Outcomes
a)Cost data b)2 separate steps c)KEY POINT |
a)site specific preferred or you can use general data from a nat'l database
b)2 step process; find out units of HC resource use and then find out cost per unit of HC use c)Clinical outcome measured/presented in NATURAL UNITS |
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CEA reporting of results you should report.... (COST EFFECTIVENESS ANALYSIS) (3)
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1)perspective taken
2)describe in detail costs and consequences 3)methods and sources of data |
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Only persepctive concerned w/ QUALY
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SOCIETY
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