Pharm Care/management Test 4 Set 1

Front 1

Economic eval measures (5)

Back 1

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)

Front 2

Humanistic evaluations (4)

Back 2

1)QOL
2)patient preferences
3)pt satisfaction
4)WTP (willingness to pay)

Front 3

Clinical evaluations (3)

Back 3

1)experimental
2)quasi-experimental
3)epidemiologic

Front 4

Experimental eval (3)

Back 4

1)RCT
2)double blind
3)cross over

Front 5

Epidemiologic eval (3)

Back 5

1)case control
2)cohort
3)field trial

Front 6

Pharmacoeconomics/ECHO model has drawn from.... (5)

Back 6

1)economics
2)pharmacy
3)medicine
4)epidemiology
5)social sciences

Front 7

Pharmacoeconomics concepts introduced...

Back 7

in 1979 by McGhan, Rowland, Bootman in AJHP

Front 8

Who and when decided dosing of AG's is beneficial

Back 8

1979 bootman

Front 9

Who and when introduced the term pharmacoeconomics

Back 9

1986 Townsend/Glaxo

Front 10

____ is linked to the success of pharmacoeconomics and outcomes research

Back 10

MTM/Pharmaceutical care

Front 11

ECHO?

Back 11

economic, clinical, humanistic outcomes

Front 12

ECHO clinical outcomes (3)

Back 12

1)medical event that occurs as a result of disease/treatment
2)measures pts physical and biomedical status
3)infers degree of disease

Front 13

Factors affecting clinical outcomes are mainly....and 4 of em

Back 13

ECONOMIC
1)labs
2)rads
3)visits
4)hospitalizations

Front 14

Economic outcomes in ECHO (4)

Back 14

1)total costs of medical care w/ treatment alternatives to achieve clinical and humanistic outcomes
2)medical
3)non-medical
4)productivity costs

Front 15

Factors affecting economic outcomes (2)

Back 15

1)clinical and/or humanistic outcome
2)persepctive

Front 16

ECHO Humanistic outcomes (3)

Back 16

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

Front 17

ECHO humanistic important factors (5)

Back 17

1)lost productivity
2)ADR's
3)efficacy/effectiveness
4)WTP compliance
5)pt knowledge

Front 18

Economic Analyses w/ ECHO characteristics (4)

Back 18

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

Front 19

Def of
a)costs
b)consequence
via ECHO

Back 19

a)VALUE of ALL resources consumed by a service or treatment
b)Effect, outputs, and outcomes of the service or treatment

Front 20

Direct Costs involves...(2) and 2 types

Back 20

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

Front 21

Direct medical costs (5)

Back 21

1)hospitalizations
2)drugs
3)labs
4)rads
5)ER, etc

Front 22

Direct non-medical costs (2 and 3ex)

Back 22

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

Front 23

Indirect Costs (1 and 4ex)

Back 23

1)costs resulting from morbidity and mortality (controversial)
2)UNPAID
3)lost productivity
4)missed work
5)cost of premature death

Front 24

Intangible Costs (2 and 3ex)

Back 24

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

Front 25

Incremental Costs
a)desc (4)
b)at some point...
c)ex (2)

Back 25

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

Front 26

Marginal Costs (2 and 1ex)

Back 26

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

Front 27

Opportunity Costs (1 and 1ex)

Back 27

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

Front 28

Perspective desc (3 and 4ex and 1 special ex)

Back 28

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

Front 29

Patient Perspective of
a)cost
b)consequences

Back 29

1)OOP expenses (copay and so on) AND indirect costs by be important
2)clinical outcomes/effects

Front 30

Provider Perspective (4)

Back 30

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

Front 31

Payer Perspective
a)ex (3)
b)costs...
c)desc

Back 31

1)insurers, gov't, employers
2)charges allowed or reimbursed
3)primarily direct medical costs but indirect costs may be important to employers

Front 32

Important indirect costs from the payer/employer prospective (3)

Back 32

1)lost productivity
2)sick days
3)excess manpower

Front 33

Societal Perspective
a)costs
b)primary use
c)CONTROVERSIAL SO...

Back 33

a)ALL relevant costs and outcomes
b)for public health issues
c)becoming less dominate

Front 34

2 Economic Evaluations

Back 34

Full (compare 2 ore more alternatives COST AND CONSEQUENCES)

Partial (only one alternative)

Front 35

Efficacy(2) vs. effectiveness(3)

Back 35

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

Front 36

UNITS of cost for COI, CMA, CBA, CEA, CUA

Back 36

DOLLARS

Front 37

OUTCOME units of
a)COI
b)CMA
c)CBA
d)CEA
e)CUA

Back 37

a)n/a
b)equivalency
c)dollars
d)clinical effects
e)QUALY (quality extended life year)

Front 38

Cost-of-illness
a)estimates...
b)determines...

Back 38

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

Front 39

Cost-of-illness other (3)

Back 39

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

Front 40

Cost-minimization analysis
a)compares...
b)determines...
c)ex (2)

Back 40

a)2 or more alternatives that are considered =
b)determines the least costly alternative (minimizing costs)
c)brand v. generic, therapeutic equivalents

Front 41

Cost Benefit analysis
a)units
b)presented in...(2)
c)looks @...
d)___ must be EFFICIENT

Back 41

a)cost and outcomes in $
b1)benefit cost ratio
b2)net benefit (most common)
c)ALL relevant costs/outcomes
d)largest net benefit alternative

Front 42

You can compare completely different alternatives via...

Back 42

CBA**, CEA

Front 43

CBA is useful for...(3)

Back 43

1)benefits can be monetarily expressed
2)differing outcomes
3)pharmaceutical services

Front 44

Cost-effectiveness analysis basic stuff (4)

Back 44

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)

Front 45

Natural units ex (2)

Back 45

1)life year gained
2)pregnancies avoided

Front 46

Cost-effectiveness analysis
a)cost-effective vs. cost savings (2)
b)cost effective situations (3)

Back 46

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

Front 47

CEA
a)average Cost-effectiveness Ratio (2)

Back 47

1)average cost of achieveing a specific effect
2)total cost of A / Total effects of A

Front 48

CEA
a)incremental cost-effectiveness ratio (3)

Back 48

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

Front 49

CEA's
a)not appropriate to...
b)compared via...
c)useful to compare...

Back 49

a)DIRECTLY COMPARE CEAs
B)INCREMENTAL RATIOS
c)competing alternatives w/ same effect

Front 50

Discounting
a)adjust for..
b)based on...
c)used when...

Back 50

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

Front 51

Discounting also.... (3)

Back 51

1)provides a common ground for comparison
2)discounts should be varied
3)5% most commonly used

Front 52

Sensitivity analysis desc (5)

Back 52

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

Front 53

Sensitivity analysis
a)Vary key variables in the decision process (3)
b)4 types

Back 53

a1)assumptions
a2)high cost values
a3)clinical effects

b1,2,3)one-way, two-way, three-way
b4)threshold analysis

Front 54

Decision analysis (3)

Back 54

1)structure the logical and chronological order of the analysis
2)decision tree provides graphic representation
3)CEA is calculated for this

Front 55

Incrmental Cost Analysis (2)

Back 55

1)similar to incremental CEA
2)BUT only costs included in the analysis

Front 56

Applications of all these different economic analysis's (2)

Back 56

1)efficient use of scarce resources
2)rational decision making by HC policy makers

Front 57

Formulary Management decisions require more than just...(3) and...

Back 57

1)safety
2)efficacy
3)cost

1)many use economic analysis to assist in formulary decisions

Front 58

Economic Analysis in formulary management via...(4)

Back 58

1)inclusion/exclusion of drugs
2)restriction of drugs
3)deletion of drugs
4)influence prescribing patterns

Front 59

Economic Analysis in Practice/Clinical guides (5)

Back 59

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

Front 60

Economic analysis in drug use policy (3)

Back 60

1)influence MD prescribing
2)allows efficient use of drugs
3)policy success directly linked to pharmacoeconomic data

Front 61

Economic analysis in service/program eval (5)

Back 61

1)determine value of existing or proposed pharmacy service
2)widely used in:
a)ambulatory care
b)LTC
c)kinetics
d)clinical pharmacists

Front 62

Economic analysis in individual pt treatment (2)

Back 62

1)most methods eval pt groups
2)methods can be applied to individual pts

Front 63

QOL/HQL? (4)

Back 63

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

Front 64

Evaluating quality of care (4)

Back 64

1)first determine what is quality of care
2)structure
3)process
4)outcome

Front 65

History of HQL has a ___ focus...(3)

Back 65

MULTIDIMENSIONAL
a)physical
b)psychological
c)social

Front 66

General measurement instruments
a)fxn
b)multidimensional ex's (4)

Back 66

a)emphasize the negative/lower end of the health spectrum
b1)physical fxning
b2)social and role fxning
b3)mental health
b4)health perceptions

Front 67

Physical fxning is measured via... (4)

Back 67

1)limitations experienced over a defined period
2)physical abilities
3)days in bed
4)bodily pain

Front 68

Social and Role fxning is measured via...

Back 68

Social)extent of participation in social interaxns
Role)duties and responsibilties that are limited by health

Front 69

Mental health measured via... (3)

Back 69

1)psychological aspects of health
2)NOT diagnostic tools
3)frequency and intensity of symptoms

Front 70

General Health Perceptions measured by... (3)

Back 70

1)overall beliefs or evaluations of health
2)help compensate for individual differences/preferences
3)question current health and health outlook

Front 71

General Health measurement instruments
a)adv (2)
b)disadv (1)

Back 71

a1)assess relative burden of different conditions
a2)any age, ethnicity, gender

b1)do not cover specific areas or specific diseases

Front 72

Disease-specific measurement instruments (4)

Back 72

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

Front 73

Thing about QOL reading...

Back 73

MUST USE MULTIPLE MEASUREMENTS, ONE TIME MEANS NOTHING

Front 74

Psychometric considerations
a)def
b)instrument must be...(3)

Back 74

a)science of testing using questionairres to measure attributes of ppl
b1)reliable
b2)valid
b3)sensitive to change

Front 75

Pt Satifaction measurements
a)general (1)
b)must cover...(3)

Back 75

1)developed for SPECIFIC settings
a1)accessibility and continuity of care
a2)comprehensiveness of care
a3)integration of care

Front 76

CEA has been used since…

Back 76

1960s

Front 77

CEA is important for…. (2) (COST EFFECTIVENESS ANALYSIS)

Back 77

1)important for rational decision making regarding limited resources and almost unlimited demand
2)maximize resources and outcomes

Front 78

How to conduct a CEA (COST EFFECTIVENESS ANALYSIS)

Back 78

No single widely accepted method for conducting CEA

Front 79

Why no single method for doing a CEA (due to variations in...) (5) (COST EFFECTIVENESS ANALYSIS)

Back 79

1)populations
2)settings
3)disease
4)treatments
5)lack of time, data, $

Front 80

CEA goal, and units of cost/outcomes (COST EFFECTIVENESS ANALYSIS)

Back 80

G)ID, examine, and compare the COSTS AND CONSEQUENCES of competing treatment alternatives
Cost in dollars
Consequences/outcomes in natural u

Front 81

CEA is used to…. (COST EFFECTIVENESS ANALYSIS)

Back 81

Assess whether outcome is worth cost

Front 82

CEA 3 types of results and are dependent on…. (COST EFFECTIVENESS ANALYSIS)

Back 82

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

Front 83

CEA does NOT…. (COST EFFECTIVENESS ANALYSIS)

Back 83

Monetarily value life or outcomes, they are identified by clinical objectives

Front 84

Name of CEA resultant and 3ex (COST EFFECTIVENESS ANALYSIS)

Back 84

COST-EFFECTIVENESS (CE) RATIO
1)cost per case cured
2)cost per death avoided
3)cost per mmHg blood pressure decreased

Front 85

CEA allows for rational decision making via…. (2) (COST EFFECTIVENESS ANALYSIS)

Back 85

1)lowest cost therapy NOT necessarily the most cost-effective
2)most effective therapy NOT necessarily most cost-effective

Front 86

CEA alternatives must…. (COST EFFECTIVENESS ANALYSIS)

Back 86

HAVE SAME CLINICAL OUTCOMES, cannot compare 2 alternatives w/ different effect (BIG LIMITATION)

Front 87

CEA cautions (when looking at one) (2) (COST EFFECTIVENESS ANALYSIS)

Back 87

1)often used when only costs are compared
2)often used in place of CMA

Front 88

3 things on defining the problem in CEA (COST EFFECTIVENESS ANALYSIS)

Back 88

1)clearly define it
2)must be specific and descriptive (should include time frame too)
3)include perspective****

Front 89

In identifying TREATMENT ALT in CEA you must….(7) (COST EFFECTIVENESS ANALYSIS)

Back 89

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)

Front 90

____ studies require the most ppl

Back 90

ECONOMIC (more than clinical even)

Front 91

Research design for CEA (experimental) (COST EFFECTIVENESS ANALYSIS) (4)

Back 91

1)piggy-backing
2)economic clinical trial or naturalistic trial
3)observational
4)simulations (modeling)

Front 92

CEA piggy backing (5) (COST EFFECTIVENESS ANALYSIS)

Back 92

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

Front 93

CEA economic clinical trial (or naturalistic trial) (COST EFFECTIVENESS ANALYSIS) (6)

Back 93

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

Front 94

CEA observational (COST EFFECTIVENESS ANALYSIS)

Back 94

claims data analysis

Front 95

CEA simulations (modeling) (COST EFFECTIVENESS ANALYSIS) (3)

Back 95

1)inexpensive
2)combines data from medical lit, CT, meta-analysis, opinions
3)uses computer based visualzation decision tree

Front 96

Identifying and measuring outcomes for CEA (COST EFFECTIVENESS ANALYSIS) (3)

Back 96

1)narrow scope of analysis for practicality reasons
2)only include significant and relevant outcomes
3)perspective must align w/ ALL outcomes

Front 97

Measuring and Valuing Costs and Outcomes
a)Cost data
b)2 separate steps
c)KEY POINT

Back 97

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

Front 98

CEA reporting of results you should report.... (COST EFFECTIVENESS ANALYSIS) (3)

Back 98

1)perspective taken
2)describe in detail costs and consequences
3)methods and sources of data

Front 99

Only persepctive concerned w/ QUALY

Back 99

SOCIETY