Pharm Care/management Test 4 Set 2

Front 1

CEA ratio's involve what in numerator and denominator (COST-EFFECTIVENESS ANALYSIS)

Back 1

1)Treatment costs in N (TC)
2)Effects in D (TE)

Front 2

Average CE ratio (ACE)
a)provides what? (2)
b)formula
c)how is value limited?
(COST-EFFECTIVENESS ANALYSIS)

Back 2

a1)ESTIMATE of average cost and effect
a2)decription of both costs and consequences of a specific alternative
b)TC / TE
c)not useful for comparing competing alternatives

Front 3

Incremental Cost-Effectiveness Ratio (ICE)
a)allows for.... (2)
(COST-EFFECTIVENESS ANALYSIS)

Back 3

a1)comparison of 2 competing (NON-similar) alternatives based on costs and consequences
a2)tells how much paying to get additional successful outcome

Front 4

Marginal Cost-effectiveness ratio (MCE)
a)similar to...
b)only...
c)what it compares
(COST-EFFECTIVENESS ANALYSIS)

Back 4

a)similar to ICE
b)only 1 alternative considered
c)compares multiple levels of same alternative (like 10mg of drugA vs 20mg of drugA)

Front 5

CEA limitations (5)
(COST-EFFECTIVENESS ANALYSIS)

Back 5

1)CE ratio alone is of little value
2)accuracy of ratio is dependent on quality of data used
3)assumpions are made in regards to treatment and cost
4)NO SUCH THING AS AVERAGE PT
5)cannot interpret ratio's generated from different studies

Front 6

Sensitivity analysis fxn in CEA (COST-EFFECTIVENESS ANALYSIS) (4)

Back 6

1)helps offset inherent limitations
2)vary key probabilities/costs used in decision process
3)vary assumptions made too
4)TESTS ROBUSTNESS OF RESULTS AND MODEL

Front 7

Interpreting Sensitivity Analysis
a)If Variations have NO impact on decision then.... (3)
b)If variations DO impact decision then...
(COST-EFFECTIVENESS ANALYSIS)

Back 7

a1)model and results are robust
a2)more dependable
a3)resistant to changes in data

b)must eval how likely that these variations will occur

Front 8

When evaluating a CEA look @.... (5)
(COST-EFFECTIVENESS ANALYSIS)

Back 8

1)perspective
2)alternatives evaluated
3)outcomes
4)costs
5)#/type of sensitivity analyses

Front 9

CMA revolves around...
(MINIMIZATION)

Back 9

DETERMINING EQUIVALENCE

Front 10

CMA def
a)def (3)
b)consequences must...
c)objective
d)incorrectly referred to as...
(MINIMIZATION)

Back 10

a1)pharmacoeconomic tool
a2)compares all relevant costs and consequences (w/ same units and must be =)
a3)compare 2 or more therapeutic alternatives

b)MUST BE EQUAL
c)choose the least costly alternative
d)cost analysis

Front 11

Methods for CMA (5 of about 10) (MINIMIZATION)

Back 11

1)search literature to make sure products are =
2)define problem
3)establish study perspective
4)Determine Alternatives/outcomes
5)probability of outcomes

Front 12

CMA vs. CEA

Back 12

CMA- costs in $; effects in natural units; effects equivalent

CEA- costs in $; effects in nautral units; effects NOT equivalent

Front 13

Definition of the MAIN problem in CMA (MINIMIZATION)

Back 13

least costly alternative

Front 14

Algorithm to determine if CMA, Cost analysis, CEA, CBA, CUA

Back 14

Are Outcomes considered
YES)Are Outcomes equivalent?
NO)Cost Analysis

Are outcomes equivalent
YES)CMA
NO)CEA, CBA, CUA

Front 15

____ limits application of CMA and some outcomes measures (4)

Back 15

1)equivalent outcomes

1)brand vs. generic
2)ROA w/ same drug
3)different setting w/ same drug
4)therapeutic equivalent drugs

Front 16

Besides equivalence what must also be considered w/ CMA? (3)

Back 16

1)negative outcomes
2)impact on outcome
3)cost to treat

Front 17

How to determine equivalence in CMA? (3)

Back 17

1)no single method
2)statistical evidence best
3)in published literature

Front 18

Statistical equivalence can be due to....

Back 18

small sample size

Front 19

Clinical study when determining equivalence should be.... (2)

Back 19

1)same elgibility criteria across studies
2)same research design across studies

Front 20

All ____ must be considered

Back 20

ALL REVELANT EQUIVALENTS

Front 21

____ of analysis must be considered too

Back 21

TIMELINE

Front 22

Cost measurement in a CMA is divided into 2 categories

Back 22

1)resource utilization units
2)labor cost should be included

Front 23

Most common perspective in CMA

Back 23

PAYER

Front 24

Results of CMA are expressed in....

Back 24

TOTAL COSTS broken down by category

Front 25

CMA applications (4)

Back 25

1)generic vs. brand
2)different routes of admin for a drug
3)different settings for a drug
4)therapeutic equivalents

EQUIVALNCE!!!

Front 26

Evaluating CMA (3)

Back 26

1)look @ perspective
2)therapeutic evidence of equivalence proven
3)make sure costs are correct via ID and valuation

Front 27

Def of CBA (cost-benefit analysis)

Back 27

compares value of all resources consumed in an intervention against the value of the outcome from the intervention

Front 28

2 main characteristics of method (CBA)

Back 28

1)values outcomes of alternatives in MONETARY terms NOT natural units
2)lets you compare anything to anything regardless of outcomes being measured

Front 29

Valuation of outcomes are in equivalent...

Back 29

MONETARY units

Front 30

What is a COST ANALYSIS?

Back 30

tells which is cheapest, doesn't care about anything else

Front 31

Scope of CBA

Back 31

broad/societal

Front 32

Adv of CBA over CEA, CUA, CMA

Back 32

those 3 do NOT lend themselves to determining whether or not a program should be implemented or continued

Front 33

CBA allows comparison of...

Back 33

investment costs and returns in dollars

Front 34

CBA most appropriate when.. (2)

Back 34

1)objective are broad in scope
2)when alt. outcomes are NOT equivalent and can easily be converted to $

Front 35

Externality def

Back 35

when axns of of one individual interferes w/ the actions of another individual

Front 36

(-) externality ex

Back 36

threat of illness to healthy ppl posed by communicable diseases

Front 37

(+) externality ex

Back 37

immunizations provide herd immunity

Front 38

CBA methods (6)

Back 38

1)determine perspective (usually societal)
2)ID and value costs and benefits
3)determine total benefits and total costs
4)calc net benefit, net present value
5)interpret data
6)sensitivity analysis

Front 39

What can bias CBA cost data (2)

Back 39

1)not including all relevant costs can bias results to favor implementation
2)including irrelevant costs can bias results against implementation

Front 40

Retrospective vs. prospective collection of cost data in CBA (2)

Back 40

1)retro is convenient and available but not captured for economic research
2)pro is collected just for the economic research project

Front 41

IDing benefits in a CBA
a)heavily dependent on...
b)includes...(3)

Back 41

a)perspective taken
b1)direct
b2)indirect
b3)intangible benefits

Front 42

Direct benefits in a CBA (2)

Back 42

1)personal health- reductions in morbidity and mortality
2)resource- savings in resource utilization thru MD visit reductions, etc

Front 43

Valuation of cost and benefits in CBA (2)

Back 43

1)valuation in $
2)based on opportunity cost

Front 44

2 types of valuing direct benefits

Back 44

1)personal health benefits
2)medical resource benefits

Front 45

If a personal health benefits saves a life you must eval...

Back 45

value of life saved thru human capital approach and WTP

Front 46

Human capital approach of valuing direct benefits in a CBA

Back 46

output or productivity, value of life based on contribution to society

Front 47

WTP approach of valuing direct benefits in a CBA (and 1 disadv)

Back 47

1)based on amt an person would pay to reduce a risk
2)difficult to apply

Front 48

Direct medical resounce benefits in CBA (3)

Back 48

1)savings in resource utilization
2)capture value of decr utilization of all aspects of HC resources
3)comes thru estimation of costs averted

Front 49

ex of estimation of direct medical resource benefits

Back 49

Est. cost of treating disease w/o intervention minus the cost of treating disease w/ the intervention

Front 50

Valuing indirect benefits in a CBA (2)

Back 50

1)measure productivity gains from HC interventions
2)measure interventions ability to return sick back to workforce

Front 51

Valuing intangible benefits in CBA (3)

Back 51

1)difficult
2)should NOT be backbone of alternative selection
3)WTP method incorporates intangible benefits

Front 52

Presentation of results of CBA via... (5)

Back 52

1)net benefit
2)net present value NPV
3)ratio analysis
4)internal rate of return
6)discounting

Front 53

Net benefit presentation of results in CBA (2)

Back 53

1)most common
2)choose one w/ largest benefit

Front 54

Net present value presentation of results in CBA (4)

Back 54

1)if benefit extends beyone ONE YEAR then net benefit must be adjusted
2)sum of all benefits minus sum of all costs discounted by interest
3)TELLS PRESENT VALUE TODAY
4)choose one alternative w/ greatest NPV

Front 55

Ratio analysis presentation of results in CBA (1 and 2ex)

Back 55

1)calc ratio fo benefits to costs or v.v.
2)exB:C = 2:1; for every $2 benefit requires $1 investment
3)exC:B = 0.5:1; for every 50cents invested gain $1 benefit

Front 56

Internal rate of return presentation of results in CBA (1 and 3ex)

Back 56

1)determines interest rate @ which net benefits are = to 0
2)If IRR is GREATER return from investment in the alternative is better than if $ were invested elsewhere
3)if IRR is EQUAL, indifference
4)if IRR is LESS, better to invest elsewhere

Front 57

Net Benefit vs. Ratio in presenting a CBA (2)

Back 57

1)net benefit most preferred method of presenting results
2)ratio's do not provide indication of magnitude of benefits or costs involved

Front 58

Discounting presentation of results in CBA (5)

Back 58

1)when cost/benefits extend beyond 1 year
2)based on time preference for money
3)prefer to receive dollar now rather than later
4)willing to recieve less money if we can recieve it earlier
5)failure to discount could bias result

Front 59

Discount rate (2)

Back 59

1)no consensus on choice of rate
2)5% commonly used

Front 60

Evaluating the outcome of CBA look @... (2)

Back 60

1)measurement
2)valuation

Front 61

Evaluating the costs of CBA look @... (2)

Back 61

1)ID all costs incurred (direct, indirect, etc)
2)ID economic benefits
3)valuing

Front 62

Sensitivity analysis for what in a CBA (3)

Back 62

1)indirect/intangible costs
2)discount rate
3)outcome valuation

Front 63

CBA used a lot w/...

Back 63

disease specific intervention (smoking, DM, childhood injury