Econ Baggarly Exam 2 (Cost-Effectiveness/Cost-Utility)
b
"If a drug can work" (under ideal conditions) a) effectiveness b) efficacy
a
"If a drug does work" (in real-world practice) a) effectiveness b) efficacy
intermediate
(Intermediate/Primary) outcomes are "surrogate" outcomes used when determining cost-effectiveness.
primary
(Intermediate/Primary) outcomes are ideal measures of cost-effectiveness.
primary
(Intermediate/Primary) outcomes include cure of a disease, eradication of an infection, and life years saved by the treatment.
intermediate
(Intermediate/Primary) outcomes include lab tests or disease markers such as cholesterol levels or blood pressure measurements.
primary
(Intermediate/Primary) outcomes may not be feasible to collect because of time or financial considerations.
λ
A sensitivity analysis will use a range around what value?
cost-consequence
A(n) ________ analysis present costs and various outcomes, but no ratios are calculated.
1
Alternative (1/2) in a standard gamble is a treatment with 2 possible outcomes, either normal health or immediate death.
2
Alternative (1/2) in a standard gamble is the certain outcome of a chronic disease state for life based on a person's life expectancy.
1
Alternative (1/2) in a time trade-off is a certain disease state for a specific length of time, the life expectancy for a person with the disease, and then death.
2
Alternative (1/2) in a time trade-off is being healthy for a length of time that's shorter than the amount of time with the chronic disease.
same
Alternative outcomes of cost-effectiveness analyses are measured in (different/the same) clinical units.
one
Cost-effectiveness analyses compare (multiple/one) outcome(s) at a time.
cost-utility
Difficulty in determining an accurate preference weight value is a disadvantage of ________ analyses.
4 (5 x 0.8)
Drug A saved 5 years of life with a utility score of 0.8 for each year of life saved. What are the QALYs?
cost-effectiveness
Effectiveness of treatment and side effects differing significantly between alternate agents (chemo, etc.) is a disadvantage of ________ analyses.
sum the products of utility scores and length of life
How are QALYs calculated?
x / t
How is the utility value calculated in a time trade-off?
<
In a time trade off, x is always (>/<) t.
x
In a time trade-off, time (t/x) is varied until the respondent is indifferent between the 2 alternatives.
quality
Morbidity relates to (quality/quantity).
a
More interested in effectiveness a) pharmacoeconomic studies b) randomized clinical trials
quantity
Mortality relates to (quality/quantity).
b
Often establish efficacy for the FDA a) pharmacoeconomic studies b) randomized clinical trials
more; less
One treatment will "dominate" another when using an incremental cost-effectiveness ratio when it is (less/more) effective and (less/more) expensive.
cost-effectiveness
Outcomes in units familiar to practitioners is an advantage of ________ analyses.
cost-efficacy
Pharmacoeconomic studies formed from randomized clinical trial data may be called "________ studies."
higher; higher (or lower; lower)
Procedures/drugs with a (higher/lower) cost and a (higher/lower) effectiveness should be compared using an incremental cost-effectiveness ratio.
excluded
Protocol-driven costs should be (excluded/included) when randomized clinical trial data is used to estimate costs/outcomes in the general population.
probably unnecessary
Quality adjustment is (needed/probably unnecessary) if the quality of each year of life between the treatments is similar.
probably unnecessary
Quality adjustment is (needed/probably unnecessary) if two pharmaceutical products have different outcomes, such as a difference in the number of life-years saved.
needed
Quality adjustment is (needed/probably unnecessary) when length of life differs between treatments.
needed
Quality adjustment is (needed/probably unnecessary) when quality of life differs based upon the treatment.
direct
Rating scale, standard gamble, and time trade-off are examples of (direct/indirect) elicitation methods for utility values.
time
Rating scales don't incorporate ________ into the utility score as easily as other methods.
cost-effectiveness
Some consider cost-utility analyses as a subset of ________ analyses.
indirect
Standardized weighting surveys are an example of a(n) (direct/indirect) elicitation method for utility values.
$1,200 per cure ($600 / 0.5)
The cost of Drug A is $600 per year. There are 130 GI SFDs, and 50% of patients are healed. What is the average cost-effectiveness ratio when comparing the cost and % of patients healed?
$4.61 per SFD ($600 / 130)
The cost of Drug A is $600 per year. There are 130 GI SFDs, and 50% of patients are healed. What is the average cost-effectiveness ratio when comparing the cost and GI SFDs??
$6.40 [($210-$530) / (200-250)]
The cost of Drug B is $210 per year. There are 200 GI SFDs, and 70% of patients are healed. The cost of Drug C is $530 per year. There are 250 GI SFDs, and 80% of patients are healed. When comparing these drugs in an incremental cost-effectiveness ratio, what is the extra cost per GI SFD?
$3,200 [($210-$530) / (0.7-0.8)]
The cost of Drug B is $210 per year. There are 200 GI SFDs, and 70% of patients are healed. The cost of Drug C is $530 per year. There are 250 GI SFDs, and 80% of patients are healed. When comparing these drugs in an incremental cost-effectiveness ratio, what is the extra cost per extra healed ulcer?
positive
The incremental cost-effectiveness ratio will be (negative/positive) if one treatment is more effective but more expensive than another.
negative
The incremental cost-effectiveness ratio will be (negative/positive) when a treatment is both more effective and less expensive.
$14,038 [($5,000 / 130) x 365]
The mean cost for basic supportive care for breast cancer is $5,000. The mean survival days with this treatment is 130. What is the cost per life year saved?
$23,397 {$5,000 / [(130 / 365) x 0.6]}
The mean cost for basic supportive care is $5,000 with 130 survival days and a utility score of 0.6. What is the average cost per QALY?
$26,071 {[($10,000 - $5,000) / (200 - 130)] x 365}
The mean cost for basic supportive care is $5,000 with 130 survival days. The mean cost for Oncoplatin is $10,000 with 200 survival days. What is the incremental cost per life year saved for Oncoplatin?
no [$50,000 x (0.19 - 0.15)] - ($10,000 - $7,000) = -$1,000 which is <0
The mean cost of Oncoplatin is $10,000 with a QALY of 0.19. The mean cost of Oncotaxel is $7,000 with a QALY of 0.15. The maximum willingness to pay for a QALY is $50,000. Is Oncoplatin cost-effective when compared with Oncotaxel?
$75,000 [($10,000 - $7,000) / (0.19 - 0.15)]
The mean cost of Oncoplatin is $10,000 with a QALY of 0.19. The mean cost of Oncotaxel is $7,000 with a QALY of 0.15. What is the incremental cost per QALY for Oncoplatin?
-$6,000 {[$50,000 x (0.19 - 0.21)] - ($10,000 - $5,000)}
The mean cost of Oncoplatin is $10,000 with a QALY of 0.19. The mean cost of basic supportive care is $5,000 with a QALY of 0.21. What is the incremental net benefit of Oncoplatin vs. basic supportive care when the maximum willingness to pay for a QALY is $50,000?
0.21 [(130 / 365) x 0.6]
The mean survival days for basic supportive care is 130 with a utility score of 0.6. What is the QALY?
yes [$5 x (90-45)] - ($537-$320) = $8 which is >0
The total cost of BreatheAgain (new drug) is $537 and has 90 symptom-free days. The total cost of ICS (old drug) is $320 and has 45 symptom-free days. Patients are willing to pay $5 per symptom-free day. Is treatment with BreatheAgain cost-effective?
lower
Time trade-off scores are often (higher/lower) than standard gamble scores.
true
True or False: An advantage of cost-effectiveness analyses is that outcomes do not have to be converted to monetary values.
false (may differ depending on method used)
True or False: Average utility scores are always the same no matter the method used to obtain them.
true
True or False: Caregivers can be used to determine utility values when patients cannot respond.
false (required in cost-benefit not cost-utility)
True or False: Cost-utility analyses require a monetary estimate of the value of health outcomes.
false
True or False: Costs/outcomes in randomized clinical trials are often the same as those in the general population.
true
True or False: Different types of health outcomes as well as diseases with multiple outcomes of interest can be compared with one common unit in a cost-utility analysis.
true
True or False: Rarely, negative utility values may be used if the disease state is considered worse than death in a cost-utility analysis.
false
True or False: Utility measures are sensitive to small changes in health status.
preference values, preference weights
Utilities in a cost-utility analysis are sometimes called "________" or "________."
disability-adjusted life years, healthy-year equivalents
What are 2 other common outcome units used in cost-utility analyses?
comparing very different/unrelated treatments/outcomes, conditions impacting quality of life but not length
What are 2 uses for cost-utility analyses?
erectile dysfunction, hearing loss, seasonal allergies
What are 3 examples of conditions that impact quality of life but not length of life?
cost-consequence analysis, cost-effectiveness ratio, incremental cost-effectiveness ratio
What are 3 methods used when presenting costs and effectiveness in pharmacoeconomic studies?
quality-adjusted life years
What are clinical outcomes usually measured in in cost-utility analyses?
direct elicitation, indirect eliciation
What are the 2 broad methods used to estimate utility weights for various conditions between perfect health and death?
develop description of disease state/condition; choose method for determining utilities; choose subjects who'll determine utility values; sum product of utility scores and length of life for each option
What are the 4 steps in calculating QALYs?
max acceptable willingness to pay
What does "λ" stand for in the incremental net benefit equation?
probability of immediate death from treatment
What does 1-p stand for in standard gamble?
probability of normal health from treatment
What does p stand for in standard gamble?
specific length of time with a disease state
What does t stand for in a time trade-off?
specific length of time of being healthy
What does x stand for in a time trade-off?
cancer treatment
What is a situation where quality adjustment is needed?
incremental net benefit analysis
What is another term for "net benefit framework" or "net monetary benefit"?
no treatment
What is the comparison made in cost-effectiveness ratios related to?
difference in cost / difference in QALYs
What is the equation used for a cost-utility analysis?
cost-effectiveness analysis
What is the most common pharmacoeconomic analysis found in pharmacy literature?
0-1
What is the range used for utility values in a cost-utility analysis?
indifference point between intervention and living with chronic condition
What is the utility value associated with in standard gamble?
dollars
What unit are costs measured in in a cost-effectiveness analysis?
natural health units (cures, lives saved, BP reduction)
What unit are outcomes measured in in a cost-effectiveness analysis?
0
What utility value signifies death in a cost-utility analysis?
1
What utility value signifies perfect health in a cost-utility analysis?
>0
When the incremental net benefit is ________, the new drug is more cost-effective than the comparator.
decreased
When using standard gamble, the percent chance of success is (decreased/increased) until the person reaches their point of indifference if they would have the intervention.
increased
When using standard gamble, the percent chance of success is (decreased/increased) until the person reaches their point of indifference if they wouldn't have the intervention.
a
Which direct elicitation method for utility values does not have to be administered in a face-to-face setting? a) rating scale b) standard gamble c) time trade-off
b
Which direct elicitation method for utility values is considered the gold standard? a) rating scale b) standard gamble c) time trade-off
time trade-off
Which direct elicitation method for utility values is more adaptable to disease states: standard gamble or time trade-off?
c
Which method of presenting costs and effectiveness answers the question "How does one treatment compare with another treatment in costs and outcomes?" a) cost-consequence analysis b) cost-effectiveness ratio c) incremental cost-effectiveness ratio
a
Which of the following direct elicitation methods for utility values is consistently lower than the others? a) rating scale b) standard gamble c) time trade-off
natural health unit
Which of the following is a more precise measurement: natural health unit or utility measure?
quality-adjusted life years
________ incorporate both quality and quantity of life.
sensitivity analyses
________ should account for possible differences between randomized clinical trial results and those of a larger population when data from the trial is used to estimate costs/outcomes in the general population.
incremental net benefit analysis
an estimate of the value for health benefits (outcomes) is included in this formula
cost-utility
analysis that takes patient preferences into account when measuring health consequences
resources used / unit of clinical benefit
cost-effectiveness ratio = ________
time trade-off
direct elicitation for utility values where the subject is offered 2 alternatives; utility value is calculated at the indifference point between life expectancy with a chronic condition and number of healthy years before death
rating scale
direct elicitation method for utility values that consists of a line on a page with scaled markings, somewhat like a thermometer with perfect health at the top and death at the bottom
standard gamble
direct elicitation method for utility values where each subject is offered 2 alternatives; they're then asked to determine the point of their indifference between the 2 possible outcomes for an intervention to determine the utility value
difference in costs / difference in outcomes
incremental cost-effectiveness ratio = ________
(λ x change in effects) - change in costs
incremental net benefit = ________
incremental cost-effectiveness ratio
indicates the magnitude of the added cost for each unit of health improvement