Economic evaluation
What is economic evaluation
Deals with inputs and outputs (costs and consequences)
the comparative analysis of courses of action in terms of both costs and consequences
What is cost effectiveness analysis
• Costs and outcomes are combined into a single measure e.g reduction in blood pressure
• Allows comparison between treatments in the same therapeutic area only
: benefit in natural units (life-years)
How are evaluations conducted
Two approaches:
1.Conducted alongside RCT (Randomized Controlled Trial) or non-randomised studies (such as before and after studies)
▫Collect primary (new) data
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2.Rely on existing (secondary) data or existing studies
▫Technology Assessment Reviews (TARs) for NICE
What are the arguments for and against age-based rationing being applied to macro-level resource allocation decisions?
• For - Treatment and care of elderly people is very costly so 'cost-effective' argument might require resources elsewhere
• Against - Most of the elderly burden relates to cost of illness and incapacity rather than age, young person with chronic/serious disease could also cost the same amount
What is consequentilism
The correct moral response is related to the outcome or consequence of the act
what are economic evaluations concerned with?
Concerned with choices – resources are scarce so decisions have to be made
what is cost utility
• Combines multiples outcomes into a single measure (QALY) using QoL instruments e.g EQ5D
• Allows comparisons between alternatives in different therapeutic categories e.g CV and cancer
What is cost minimisation analysis
• Chooses cheapest option between treatments that have identical outcomes
What are the arguments for and against age-based rationing being applied to micro-level resource allocation decisions?
• For - Age should be relevant because older people are less likely to respond to treatment and have a poorer prognosis in general due to increased complication risk
• Against - Age alone is not a good predictor of prognosis/complications hence need case-by-case decisions, decisions based on age may be hidden form of discrimination
What is deontology
Places value on the intentions of the individual and focuses on rules, obligations and duties
what do economic evaluation aim to do
Evaluations aim to make these choices explicit
what is cost benefit analysis
• Puts cost and benefit into monetary/numerical terms, e.g. how much is the 3 months gained worth to the patient?
What are the arguments for QALY-based assessments?
• Maximises healthcare based on quality and quantity of life
• Considers individual patient level when informing decisions about whether or not to proceed with an invasive procedure based on QALys they are likely to gain
What is virtue ethics
Right living is derived from the moral character of the agent
what are the basic steps of economic evaluation
•Identify
•Measure
•Value
•Compare costs and consequences of the alternatives
what kind of comparison does cost effectiveness analysis allow for
Allows comparison between treatments in the same therapeutic area only
What are the arguments against QALY-based assessments?
• Difficulties in mesuring - How do you measure quality or value or life? Who makes the decisions? Introduces bais
• Can seem unjust - Can favour life years over individual lives
What are the 4 ethical principles?
Beneficence - Duty to do good
Non-maleficence - Duty to not cause harm
Autonomy - Patient has the right to make their own decision
Justice - Fair, equitable treatment for all
who uses economic evaluation
NICE
Scottish medicine consortium
What kind of analysis does cost-utility analysis allow for
Allows comparison between alternatives in different therapeutic categories e.g CV and cancer
What is the relationship between age and QALY?
• The older you are the fewer QALYs you will gain due to lower life expectancy + comorbidities
• Doesn't aim for ageism but it is still discriminatory (indirect)