b2.docx

Cost Utility Analysis, Health Status Measures vs. Utility Measures Discuss the advantages and disadvantages of cost utility analysis (CUAs) Advantages Disadvantages Includes “patient” preferences Provides a single measure which includes both morbidity and mortality Allows for comparison a...

Cost Utility Analysis, Health Status Measures vs. Utility Measures Discuss the advantages and disadvantages of cost utility analysis (CUAs) Advantages Disadvantages Includes “patient” preferences Provides a single measure which includes both morbidity and mortality Allows for comparison across different treatment options Does not attempt to place a dollar value on a human life Provides societal perspective: cost-benefit does not Time-consuming, challenging methodology Results reliant upon the specific instrument utilized and the population being studied Clinicians often find methods and results difficult to understand List when a CUA is either appropriate or inappropriate When CUA should be used? When CUA should NOT be used? When QoL is an important outcome Comparing interventions that are not expected to have an impact on mortality, but a potential impact on patient function and well-being Treatments for osteoarthritis Outcomes associated with the treatment of acute myocardial infarction (quality of lives saved). Impact of a treatment-induced stroke in a survivor When treatments affect both morbidity and mortality Evaluation of a therapy, such as estrogen use by postmenopausal women that can improve QoL, may reduce mortality for certain conditions (e.g., heart disease), but may increase mortality from other conditions (e.g., uterine cancer) When treatment have a wide range of different outcomes and there is a need to have a common unit of outcome for comparison Allocating limited resources among interventions that have different objectives and benefits Choosing between providing increased prenatal care or expanding a hypertension screening and treatment program If the researcher is only concerned with intermediate outcomes (or if only surrogate markers can be obtained) When effectiveness closely correlates to QoL This may occur when a treatment is expensive When the extra cost of obtaining utility measures is judged as not ‘cost-effective’ When one treatment is truly dominant from a CEA (substantial survival) Discuss the steps in conducting a CUA Step 1: Describe the health state Hospital-Based Kidney Dialysis You feel tired and sluggish. A piece of tubing has been inserted into a vein in your arm or leg, restricting movement. No acute pain, but chronic discomfort. Visits to hospital 2-3 times a week for 8-hour visits. Strict diet, low salt, little meat, no alcohol. Many people become depressed, often feeling as if they are being kept alive by a machine Step 2: Choose an instrument Step 3: Administer the instrument To whom? General Public Societal view Will they understand the disease? People with the disease Patients adapt or adjust to the disease state or condition Health Professionals/Disease Experts May not rate discomfort and disability as seriously as patients or the general public Do not have to describe or explain the disease Caregivers May over- or underestimate burden of illness Step 4: Determine utility Selected utilities from Rating Scales One thousand health related quality of life instruments: MEDICAL CARE Step 5: Calculate QALYs Compute Quality Adjusted Life Years (QALYs) QALY= (Life Expectancy) * (Health State, Utility) Give examples of health status domains Physical Functioning General Health Status Mental Health Social and Role Functioning Compare and contrast generic measures versus disease-specific Generic Measures Disease – specific Broadly applicable “main effect” Can compare across multiple populations Fewer relevant questions to detect changes within patient Meta-analysis: synthesize results of different studies Example: Medical outcome study, QALYs, sickness impact profile All items relevant to the patient population Eliminates noise of generic items that are irrelevant Less reliability and validity data available May overlook aspects of the intervention that are more important to the patient Examples: HTN, asthma, allergy, cancer, AIDS Examples of HRQoL measures in pharmacoeconomics Personalized care planning Self-assessment Annual review Informed decision making Population health Importance of measuring HRQoL Concept that reflects an individuals perception of how an illness and its treatment affect life HRQoL instruments attempt to quantify patient’s perceptions of the disease Necessary to quantify burden and functional impairment Compare and contrast different utility measures