836 Exam 1
SG utility
% of being healthy ex. 5% change in death is indifferent than utility is 0.95
Discount factor
(1/(1+r)# of years after initial year)
Incremental Cost Effectiveness Ratio (ICER)
(cost new - cost old)/(effect new - effect old) estimates how much it will cost to achieve one more unit of benefit beyond what the standard or baseline therapy provides Tells you how much cost is increased per unit of effectiveness gained when compared to the next best treatment option
Average CER
(costs/ outcomes) average CER would tell you how much it costs to achieve a unit of outcome with each treatment, does not provide information about comparative cost, typically not used because we want to compare treatments head to head and you can't do that with this
CBA differences
-CBA is broader in scope than CEA (since converts all costs and benefits to $$) -Using CBA, decisions about resource allocation can be made within AND between sectors of the economy (transportation, social services, etc. within federal and state budgets) -CBA address allocation efficiency (how to best utilize resources) -CBA does NOT address product efficiency (Maximizing outcomes like symptom free days of Life years, does not show which will give us benefit) -NOT always easy to assign $ values to non-monetary benefits- if different methods used between CBA analyses, can also make comparison of findings difficult
Traditional method of cost categories
-Direct medical -direct nonmedical -indirect - Intangible
Drummond proposed method
-Healthcare sector -other sectors -patient and family -productivity
Limitations of CEA
-ICER ratios are limited/ applicable to the single measure of benefit being used (it makes it difficult/ impossible to compare across treatments with different measures and certain primary measures miss out on other benefits like mortality doesn't capture morbidity) -ICER does not tell you by themselves whether the treatment is overall worth implementing, you need budget or WTP information to decide that -It is important to remember that most of these assessments involve using treatment effects that are population average effects, you do not always end up with the average value (there is risk) -Sometimes studies report/ use average CE ratios (total costs/ total effects) instead of ICERs, these tend to be misleading and do not inform resource allocation, so avoid using them
3 direct PPM measures
-rating scales (VAS) -Time trade off -standard gamble
Fives steps in CEA
1. Make a table of costs and effects, Sort options by total cost or effects for each option, Treatments have to be grouped by patient population where one treatment can be taken per patient 2. Eliminate first order (strictly dominated) treatments 3. Calculated incremental ratios for each successive treatment 4. Eliminate second order dominated (extended dominance) treatments 5. Calculate final ratios
Health Utilities Index (HUI)
15 questions, mark II- 7 dimensions, mark III8 dimensions, domains: vision, hearing, speech, ambulation, dexterity, emotion, cognition, pain, ease of administration, Canadian gold standard, scoring functions converted to PPMs, only instrument of vision, hearing, and speech (dimensions for senses)
Components of CBA
2 cost categories- direct and nondirect medical 3 benefits- direct, indirect, intangible
EQ-5D
5 questions, plus visual analog scale, demographics, domains: mobility, self care, usually activities, pain/ discomfort, anxiety/ depression, 245 health states, ease of administration, European goal standard
Cost-to-charge ratio
=medicare reimbursement/ covered charges the MEDPAR data from CMS includes, Medicare reimbursement (amount they actually pay), total charges (how much hospital bills), and covered charges (amount of charge that is covered)
Healthcare Cost and Utilization Project (HCUP)
A group of healthcare databases and related software tools developed through collaboration by the federal government, state governments, and industry to create a national information resource for patient-level healthcare data collected by AHRQ, hospital data (in and outpatient) and ED visits, longitudinal healthcare delivery and patient outcomes data at national, regional, state and community levels
SG advantages and disadvantages
Advantages- conceptually sound with utility theory, incorporates level of risk adversity of population Disadvantages- risk of death decisions are uncommon for most medical conditions, subjects may have cognitive difficulties understanding the trade-off between quality/ quantity of life
TTO advantages and disadvantages
Advantages- easy to explain, relatively quick to remember Disadvantages- values are not true utilities, because risk is not considered, respondents may get confused understanding the concept of trading time, unrealistic in most health care situations you don't have to choose to live fewer years
CBA vs CEA
CEA- emphasis is on minimizing costs to achieve optimal outcomes (hospitalizations averted) has specific outcome we want to achieve CEA does not provide information on whether a project/ intervention is worth investing the required resources- provides a relative measure ($10,000 to avoid an additional ED visit beyond what can be achieved by the comparator) CEA/CUA: can assist with the program decisions when outcomes are in similar units (life years or QALYs) CEA: addresses production efficiency (how to optimize outcomes, but NOT allocation efficiency)
NADAC (National Average Drug Acquisition Cost)
CMS monthly survey of outpatient drug acquisition costs for retail pharmacies (does NOT include discounts, rebates, price concessions) used as reference prices for state Medicaid plans
VAS advantages and disadvantages
Caveat: needs adjustments, based on responses from other direct PPM instruments to be considered a valid PPM Advantages- easy to explain, comparative to other rating scales, very quick Disadvantages- ordinal vs interval along scale, reliability may be suspect, impact of relatively trivial illness may be overstated, results are often lower than for other techniques
Budget vs. WTP
Fixed budget will often result in different treatments for different patients in the same group, but WTP approach will always lead to the adoption of the same treatment for all the patients in the same patient group, using WTP will implicitly yield a budget, using a fixed budget will lead to an implied WTP value for an additional unit of effectiveness
Program is not beneficial
NB<0 or B/C<1 (C/B>1) Caution may be needed with some B/C ratios, depends on degree to which some components have been considered as costs or cost savings- this is not a problem with net benefit
Program is neutral
NB=0 or B/C=1
Program is beneficial
NB>0 or B/C>1 (or C/B<1)
Discount equation
Present value= future cost x (1/(1+r)# of years after initial year)
Historical adjustment formula
Present value= historical cost x (1 + r)# of year after year estimated
Why measure QALY
Purpose of health care: gain the most "total health" for society give the resources available By comparing the HRQOL gains of different disease treatments, society can make good decisions for allocating resources, seek to maximize total amount of health state utilities by selecting treatment with the most gain and the least cost *underlying ethical goal=distributive justice*
Standardization example
Retrospective costs- you have hospital costs for 2009 ($8450) and need to adjust them to 2018, CPI for 2009= 375.613 and for 2018=484.707 2018 costs/ 8450= 484.707/375.613 =1.29 (costs have increase 29%) 2018 costs= 8450 x 1.29= $10,900 Alternative method uses average annual inflation rate across a time period
Rule of 72
The number of years it takes for a certain amount to double in value is equal to 72 divided by its annual rate of interest.
Limitations of CMA
Types of applications or interventions are limited, validity of CMA is contingent upon assumption of equivalent outcomes or benefits, cannot be used when there are important differences in outcomes of two health alternatives, tendency for inappropriate use
WTP and VSL
WTP based on value of statistical life (VSL), VSL does not estimate the value of life, it is an average estimate of what an individual (an so is based on a group assessment) is willing to pay to reduce a certain risk level or accept a risk level by not paying for the risk reduction
ICD
a comprehensive list of every disease and disease subtype
First order dominated
a program or treatment is more expensive, and provides less benefits/ effect than another program (is strongly dominated by another program), dominated programs will never be efficient, should be disregarded, do not want to spend and achieve less compared to another alternative, always remove dominated alternatives from consideration
Second order dominated
a program/ treatment is weakly dominated and subject to extended dominance if it has higher incremental ratio than the next treatment in the table, preference is to buy better outcomes at lowest cost per each additional outcome (*if you have not first sorted by either effect or cost and eliminated strongly dominated treatments your analysis will be wrong*)
PPM
a single number between 0 and 1.0 that reflects the economic concept of utility (value to society) of a health state, combines different domains of HRQOL, societal perspectives for health, can be measured for each person in a society regardless of severity of disease
Cost of Illness Analysis (COI)
a type of economic analysis that is used to estimate the total economic burden (including prevention, treatment, losses caused by morbidity and mortality) or a particular disease on society A method used to estimate the total economic burden (including prevention, treatment, losses because morbidity and mortality, and so on) of a particular disease on society.
Opportunity cost
according to the economic theory, considered to be the "true cost" of a resource, people care about cost because every effort/ expense means time/ money is not used for some other option the most desirable alternative given up as the result of a decision
CBA benefits
also called consequences or effects include cost savings or costs avoided, a reduction in costs because of an alternate program would usually be classified as a benefit -> a cost savings Example: reduce ED visits because of preventative care visits
CEA disadvantages
alternative being compared must be measured in same clinical outcome units, only *one* outcome can be compared at a time, difficult to consider intangible costs
Value of Statistical Life (VSL)
amount people are willing to pay to reduce risk so that on average one less person is expected to die from the risk extension (or reductions) in life expectancy are assigned a value for a statistical life-year, there is a large and controversial literature on the economic value of a life year, the FDA has consistently used values of $5.0-6.5 million in several of its rulemaking to monetize mortality risks, but is also uses a monetary value of the remaining life-years saved by alternative policies
cost effective analysis (CEA)
an analysis when inputs are measured in monetary values and outcomes (effectiveness measures) in natural health units that indicate an improvement in health, such as cures, lives saved, and blood pressure reductions, outcomes measured make a lot of sense for clinicians and general public, magic number 100,000 per quality Most prevalent pharmacoeconomic analysis found in pharmacy literature
Direct medical
associated with provision of healthcare goods and services, simplest to measure and the most objective, the costs associated with medical goods, examples: Rxs, OTC, doctor visits, labs, MRI, therapy
Direct nonmedical
associated with receiving healthcare goods and/ or services, but not medical in nature, costs associated with, but not part of medical goods or services received, examples: transportation, food, lodging, traveling, childcare costs
Key assumptions of CMA
benefits/ negative impacts of the treatments being compared are the same, not considered a "cost-effectiveness study), not utilized in real world, we cant assume outcomes are the same
Prevalence vs. Incidence COI
both methods give similar awareness for illness that last less than one year, long-term illness methods may give very different answers, prevalence based costs will be higher when incidence is declining, annual treatment costs are declining over time, annual treatment costs and disability losses increase as disease progresses
Medical Expenditure Panel Survey (MEPS)
collected by the AHRQ, a set of large-scale surveys of families and individuals, their medical providers, and employers across the US, useful in assessing overall cost of care for patients for medical data
QALY
combines both quantity and quality of life into one measure, how much you gain from treatment, quality of life over time HRQOL of a health state= patient preference measure (PPM) on a 0 (dead) to 1.0 scale Time spent at heath state in years *Tabulate changes in health related to quality of life (HRQOL) over time*
Common applications of CMA
comparison of two generics medications that are AB equivalent by the FDA, compare costs of receiving same medication in different setting
Society perspective
considers impact to all components: healthcare sectors, other, and patient/ family
Discounting
convert future costs to present value
Cost-Consequence Analysis (CCA)
cost effectiveness is not summarized in a single number for each treatment, but rather summaries for each component (costs and consequences) are provided -All costs together -All effects or outcomes together -In a table so you can see alternatives & choose
Inpatient care
cost per DRG or average for a given group of ICD diagnosis
Pharmacoeconomic equation
costs -> Rx -> Outcomes Compare the costs associated with providing a pharmacy product or service to the outcome of the product or service
Patient and family
costs to patient/ family members that are direct medical (co-pays, deductibles) or non-medical (child-care)
Incidence based COI
counts the number of individuals who become ill in a particular time period, and then estimates lifetime costs associated with that illness for those people, new cases/ new diagnosis in a given time period (ex. infectious disease) used to estimate potential averted costs if incident cases are prevented
Step 4 CBA
determine cost benefit (sum of benefits/ sum of costs)
TTO
developed specifically for use in health care, intended to give comparable scores to SG, subject offered two alternatives *both certain* Alternative 1= certain health state A for time t (life expectancy of individual with condition) Alternative 2= being healthy for time x (where x<t) then death Time x varied until subject is indifferent between them
Healthcare sector
direct medical costs borne by other than patient and family
Advantage of prevalence COI
draws attention to the current burden being borne by those with disease, policy decisions, provides information on the magnitude of specific costs categories
340B
drug pricing program that requires drug manufacturers to provide outpatient drugs at significantly reduced prices to eligible health care organizations and covered entities
WAC (Wholesale Acquisition Cost)
estimate of manufacturer's "sticker" or 'list price' to wholesalers, does not include discounts or rebates
AWP (Average Wholesale Price)
estimate of price paid by retail pharmacies to wholesale distributor, can be found in Micromedex, is an overestimate
Visual analog scale
have patient indicated on the scale how good or bad their health is today, has ceiling and floor effect, going from 0.1 to 0.2 could make a big impact on life where going from 0.8 to 0.9 might not have that much of an impact but since it is interval data it is shown by a 0.1 change
CEA advantages
health units are common outcomes routinely measured in clinical trials and outcomes studies, therefore familiar and acceptable to practitioners, outcomes do not need to be converted to monetary values (paying X to get a certain outcome)
PPM/QALY controversies
healthy populations vs patients with disease, sensitivity (responsiveness, may not capture differences in illness) or PPMs to disease changes/ treatment, simplicity vs. theoretical soundness, health states that do not fit between the two ends of the scales (0 to 1.0) a health state less than zero is a vegetative state
Dominated
higher cost/ lower effectiveness
factors contributing to risking health care costs
hospital costs, provider costs, medical technology, behaviors (non-adherence, alcohol/substance abuse, smoking, obesity, unhealthy life styles, increasing number of chronic diseases), aging population, skyrocketing drug spend
Healthcare institution perspective
hospital, pharmacy, clinic
Working individuals
human capital approach: estimated increases of actual earning/ productivity because of losses (absenteeism, presenteeism, disability, death) no longer occur, assess how much time is lost by looking at average wages
Choose a method for determining utilities
ideally ALL methods should be include a description of a path from baseline to death that includes one or more health states with specified time periods for states Main difference in methods- how question framed- whether the outcomes in the question are certain or uncertain
Step 3 in CBA
identify and value benefits (benefits= effects/ consequences) Benefits with an easily measured $ value: direct medical and nonmedical (cost savings) Benefits to which monetary value must be assigned (indirect and intangible) improved productivity and quality of life Indirect benefits- societal perspective, so patient/ family/ caregivers are the source of values for indirect benefits (productivity) Intangible- benefits not related to productivity, avoidance/ alleviation of intangible costs, captured by quality of life instruments
Step 2 in CBA
identify and value costs Direct medical and nonmedical, will this increase or decreases costs
Using budget as decision rule
if budget is the decision rule, choice of treatment depends on the size of budget, goal is to maximize health given a fixed budget, rules for fixed budget are based on two assumptions Patients use only one treatment: this means that the total possible treatment effect is related to the number of patients You can split budgets between treatments o 1. Put the non-dominated treatments in order of *effectiveness/ benefit* o 2. Given the budget, move to the highest level of total costs that you can among the non-dominated programs in order of their incremental costs (you may have to split funds between two programs in that case you use the two adjacent programs)
COI
illness results in consumption of resources (there are costs associated with having the illness), summarizes economic burden of an illness
Advantages of COI
informs us where/how our resources are being spent, informs us of the benefits of curing or preventing a particular illness (costs saved), provides information about which aspect of the illness, or treatment strategy is particularly costly, can be used to set priorities for health care policies, can be used by employers or payers to set reimbursement strategies, aids in determining market potential for new drug
DRG
inpatient classification scheme to incorporate case mix; groups require similar resources
PPM issues
interval measure: different from 0 to 0.1 is the same as 0.9 to 1, QALY scales are considered uniform between illnesses (0.1 gain in diabetes is same as 0.1 gain in congestive heart failure), people with lower quality of life may not get the same benefit as someone with high quality of life or vice versa
Payment card
list of options, frequently used, ceiling and floor affect
FSS (federal supply schedule)
list prices paid by VA and IHS for medications, closest value to what insurance pays
Indirect
lost work time or earnings potential due to an illness (productivity costs), costs resulting from loss or gain of productivity due to illness (morbidity) or death (premature or delay) examples: time off from work to receive treatment, missed work days, reduced productivity when at work (presenteeism)
Dominantes
lower cost/ higher effectiveness
WTP limitations
measurement biases may exist (respondents want to please interviewer, over/ under estimate WTP values), difficult to place dollar value on intangible, *in general WTP estimates are much higher than HC*
QALY controversies
measurement issues between instruments, populations, patients, use of PPMs in patients, bias against treating disease (individual adjust to their limitations, viewpoints change overtime), large variability indicates inadequacies of PPM measures
Cost minimization analysis (CMA)
measures and compares intervention/ treatment delivery costs when outcomes are assumed to be equivalent (hypothesis is one will be cost saving), focus on measuring the costs of the PE equation, outcomes are assumed to be the same
Health insurance payer perspective
medicare, Medicaid, commercial (predominant perspective)
CBA
method for comparing the value of all resources used (cost) for a program/ intervention with the value of outcomes achieved (benefits), everything put into $ value Key- costs and benefits are valued using the same monetary unit ($) Ideally benefits are more than just material costs savings: full healthcare CBA evaluations should include monetarization of indirect benefits (productivity gains) and ideally of intangible benefits If benefits exceed the costs, the program may be worthwhile
Hurdle rate
minimum acceptable rate of return the costs of acquiring capital (effective interest rate on loans, bonds) or rate that could be earned on other investment
Prevalence based approach for COI
most common, counts the number of individuals who currently have a particular illness, and aggregates all of the services being utilized for that illness for a specific time period (usually over one year), includes various stages of illness, includes the number of people with the disease during a given time period, used for chronic conditions
Micro-costing
most precise method, identifies, measures, and values each resource used, and adds them together, best used by organizations (hospitals, clinics as opposed to insurers)
Certainty
no unknowns, outcome will occur with certainty (in VAS and TTO)
other sectors
non-healthcare sector costs such as judicial system, schools
Limitations of COI
o Some costs are difficult to measure with current data, frequently intangible costs are neglected o indirect costs are often limited to morbidity and do not generally consider mortality (premature death) o Studies do not evaluate the current strategy of care (not effectiveness study), looking at a census
Uncertainty
one outcome has a probability of occurrence (in SG)
Human capital limitations
only considers time for employable persons, inequities due to degree of economic productivity (CEOs earn more than janitor), intangible benefits cannot be valued with this method
Close ended questions
only one question- take it or leave it
Medical provider analysis and review (MEDPAR)
overseen by CMS, medicare payments are listed by DRG
AAC (Actual Acquisition Cost)
paid by pharmacy to wholesaler or direct purchaser (usually proprietary)
Intangible
pain, suffering, anxiety, fatigue (difficult to put monetary value on), impacts to quality of life that are not already captured in other categories, difficult to measure, examples: pain, anxiety, hair loss, fatigue
Willingness to Pay (WTP)
pick an incremental value that you are willing to spend (pay) for a gain in benefit, then choose the option that covers the most costly treatment with an incremental ratio less than or equal to what you are willing to pay ICER<WTP
AMP (Average Manufacturer Price)
price manufacturers charge wholesalers or pharmacies after discounts, represents a more precise estimate of what pharmacies pay, but is proprietary for most drugs
SF-6D
provides means for using SF-36 and SF-12 (HRQOL instruments) in economic evaluations 6 dimensions= physical health, mental health, bodily pain, social functioning, role-limitations, vitality, describes 18,000 possible health states, preference weights were determined using SG
Key concepts of PPMs
public vs patient views of relative value (utility) of health status, values are developed from public perspective (use people that don't have illness and don't know disease burden), then applied at the patient perspective, persons experiencing the disease usually value the health state high than society (have a higher PPM value) Across society and health state, relative comparisons are theoretically valid within society (a rural NM resident vs. NY resident may not place equal value on a particular health state, but across all of society the relative PPM of the health state is measurable and comparable to other health states, difference exist between countries, each has different scaling
Internal Rate of Return (IRR)
rate of return where discounted benefits = discounted costs (don't want to borrow money to lose money, want to make more than interest rate)
Step 1 in CBA
reason for evaluation, many treatments provide additional clinical benefits but at an additional cost CBA can provide a more complete picture of the total value (what are the expected impacts? Are there monetary limits in providing program? (How disease progresses and where can we make an impact? What are the alternatives to the planned program? Not providing a program/ treatment, implementing for only selected patients (high risk, age 65 and older, women of childbearing age)
Hospital charges
represent the amounts that the hospital bills, NOT what is paid to the hospital for care (cost to payer/ patient),
Time trade off (TTO)
respondent makes choice about trading off years of life for better health for a shortened life span, potential choices are varied until subject is indifferent
Open ended questions
respondent provides amount, people don't have a frame of reference for cost of service
productivity
same as traditional, lost productivity
Pharmacoeconomics definition
scientific discipline that evaluates the clinical economic and humanistic aspects of pharmaceutical products, services, and programs (as well as other health care interventions), provides health care decision makers, providers and patients with valuable information for optimal outcomes and the allocation of health care resource, most impactful when making decisions about a population rather than an individual
Bidding game
several choices offered
Costs in economic evaluations
should be current estimates, current estimates are also used for estimates of future years (inflation not considered)
Direct measurement of PPMS
specific questions designed to determine PPMs · Specific description of health state is provided · Subjects may or may not have experiences the disease · Uniform conditions/ description to all subjects (administered the same way for everyone)
SG
subject offered two alternatives: one certain and one uncertain (gamble), alternative 1- certain outcome of a chronic disease for the rest of persons life, alternative 2- intervention that has probability of achieving normal health or probability of resulting in death, probability p varied until subject indifferent between two alternatives, useful for assessing utility for chronic conditions
Advantage of incidence COI
support for preventative initiatives (vaccines), demonstrating lifetime impact of disease and how management of disease may change
Identifying costs
take an impact inventory, look at the event pathway of your model (progression of disease) from getting sick to receiving healthcare to being cured or stabilized, identify and break down all costs that lead to the overall cost of each event, identifying small costs insures that no costs are missed (even if they are not used)
CBA costs
the costs side summarizes the costs involved with providing the treatment/ service (labor, equipment, operational expenses)
Considerations for indirect measurement of PPM
theoretical constructs (time trade-off, standard gamble, rating scales, visual analog scales), ease of administration, validity/ reliability, relevance to condition (responsiveness), *COST*
TTO utility
time in optimal health/ life expectancy
reasons to discount
time preference placed on future expenditures (this is not inflation adjustment), recommended rate is 3%, assumes costs occur in the middle of all years and 1st year costs are not discounted, cost estimates greater than a year should be discounted
Describe a health state
use concise language in describing health effects expected from the disease state condition, should include: amount of pain/ discomfort, any restriction on activities, time it may take for treatment, possible health perceptions (worry or concern), any mental changes
Direct medical costs
use gross cost data if not available do micro-costing and identify all the relevant resources that will be consumed, quantify the resources used, place a monetary value on resources used, might be based on diagnosis codes (ICD or DRG)
Willingness to pay
used for indirect and intangible Assesses amount individuals are willing to pay to reduce the chance of an adverse outcome, can be used to value both indirect and intangible benefits, incorporate preferences individuals presented with hypothetical scenario, benefits for an intervention/ treatment described, respondents asked to 'bid' or place value on the intervention/ treatment to prevent adverse outcomes
Human capital
used for indirect cost, ~70-80% of studies Pay-back value of health benefits= person's renewed or increased ability to be productive for society (work) Need wage rate and *time gained* (units= days, months, years) Wage rate is "fully loaded" includes leave, pension, benefits Self-report data for absences, presenteeism Published reports for industry
Cost effectiveness
used to describe a technology (new drug, surgery, etc.) that is both more expensive and better than the alternative being considered (the standard of care), and the added benefit of this technology is assessed to be worth the additional cost, also known as economic advantage
Cost saving
used to describe a technology that is less costly than the alternative to which it is being compared and outcomes are not a concern (assumed to be equivalent)
Standadization
using historical cost information, overtime monetary value usually decreases, to insure valuations are consistent historical costs are adjusted to current, costs collected greater than 1 year prior to current time need to be adjusted, usually use consumer price index (CPI) to estimate inflation rate
Standard gamble
utilities are preferences measured under uncertainty and involve risk, incorporate risk and uncertainty into the assessment, the percept of indifferent between the two alternatives is the PPM measure
QALY calculation
utility score x length of life/ time
VAS utility value
utility value from VAS converted to value between 0 and 1.0 (ex 65=0.65)
Indirect PPM measures
validated HRQOL survey, survey responses obtained alongside direct PPM measures, mathematically converted responses to values obtained from direct measures of PPM Validated, reliable survey instruments, responses collected as well as direct PPM in population, mathematical formulas are developed to covert responses on survey questions to PPMs Advantages-time, interviewer training, interview techniques, results within different domains of health Disadvantages- assumes the population vales are correct, relevant and appropriate
Rating scales
visual analog scale (VAS)- most common Anchors (ends of scale) 100= optimal or full health, 0= worst possible state or death How would you rate this description or your current health on this scale? Similar to other health rating scales
ASP (average selling price)
weight average of manufacturer's sales price for all purchasers, net price adjustments (discounts, rebates), used by CMS as a basis for reimbursement for Medicare Part B
Quality Well Being Scale (QWB)
weighted desirability of different health states, domains: symptoms/ problems plus mobility, physical activity, social activity, interview administered, 20 minutes, self-administered form available, weighted health state measures, used in Oregon Medicaid experiment
Gross costing
what is the average cost, use directly observed cost information (claims data), data can be obtained from a single data source; less time consuming, but isn't always available and can miss some costs
Perspectives
who is the decision maker, what are their concerns, an economic term that describes whose costs are relevant -health insurance payer -healthcare institution -society Perspectives being taken in any cost analysis is extremely important, some are too narrow and some are two wide, current recommendation is to also provide a societal perspective when perspective for decision maker is other than societal
If individual/ population not working
willingness to pay: estimate of how much someone willing to pay to not have an adverse outcome, more subjective
Pharmacoeconomics
· a multidisciplinary field including health economics, clinical and/or humanistic outcomes research, and pharmacy management, there is a tremendous growth in the cost of healthcare so economic evaluation is popular The study of economic factors impacting the cost of drug therapy.
Dominant
· used to describe a technology that is both less costly than the alternative to which it is being compared, and outcomes are better, new technology dominates the alternative
Cost
· value (time, money, labor) of resources associated with the production and/or delivery of a good or service, only costs related to illness, treatment, service evaluation should be counted, costs are not always monetary