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Opportunity cost in the context of healthcare

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Opportunity cost is the value placed on the sacrifices, regardless of whether or not money is paid for them.

Given intervention options A and B, How can we make a choice? 

If we choose A, the opportunity cost of choosing A over B is the benefits (value) we forgo had we chosen B.

It is logical that the choice would want to maximise the value received from A and minimise the value of what is given up in B.

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Definition of: 

  • Technical efficiency
  • Allocative efficiency
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Technical efficiency 

When considering how to produce any particular good or service, the aim is to achieve the maximum output from available resources, or for a given output, use the least resources possible.



Allocative efficiency

Once goods and services have been produced, the aim is to allocate these to those individuals who will derive the maximum benefit from consuming the goods or service.

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Points of: "Why Economic Evaluation?" 

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  • Resources are scarce, need to make choices and minimise opportunity cost.
  • To identify clearly the relevant alternatives.
  • Lets us consider different perspectives of the analysis
  • Allows for quantification of the magnitude of changes in costs and outcomes for competing interventions.
  • Increases the explicitness and accountability in decision-making.
  • Can be Primary or secondary research
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Different Perspectives in Economic Evaluation

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  • Individual patients :
    • All patient borne costs
  • Third party payer: Healthcare perspective 
    • Health provider resources only [e.g. Staff costs, prescribed drugs], Insurer, Reimbursements
  • Healthcare and individual patients
    • Patient borne costs and healthcare costs [Patient travel expenses, OTC medicines, hospital costs]
  • Societal perspective 
    • Includes different players in society [e.g. Carer time] and other sector costs [e.g. social costs for time off from work]
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Definition of: 

Time Horizon

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how long to measure costs and consequences

  • long enough into the future to capture important differences
    • Disease profile i.e. acute or chronic disease
    • Cost category considered e.g. those within or outside healthcare sector
    • Outcome consideration e.g. intervention removing environmental toxins can have outcomes extending beyond generations


For time horizon beyond 12 months, both costs and consequences must be discounted to show the present value.

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TESTE DEIN WISSEN

Definition of: 

Cost analysis

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TESTE DEIN WISSEN
  • Plain evaluation of the costs associated with the intervention under investigation
  • Cannot lead to recommendations or a decision**
  • Can give an idea about the costs of the intervention as part of a health economic evaluation or as a starting point for further research
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Definition of:

Cost of illness

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  • Assessment of all costs associated with an illness such as cost of treatment, cost of care, travel time, productivity loss
  • Cannot lead to recommendations or a decision
  • Can be used to assess the economic burden put on society by a certain condition
  • Can be an argument to put more research resources or more attention to a condition (Advocacy)
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Summary of healthcare evaluation:

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TESTE DEIN WISSEN
  • Economic evaluation is used in healthcare to ensure that the addition on new interventions does not displace more health than is gained.


  • To achieve this we need to:
    • Compare costs of the intervention and comparator (incremental costs)
    • Compare benefits of the intervention and comparator (incremental benefits)
    • Calculate the ICER or INB
    • Use the appropriate decision-rule


  • Uncertainty can be incorporated into the results using sensitivity analysis
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TESTE DEIN WISSEN

Objective of healthcare is to improve population HEALTH

What is health?

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“A state of complete physical, mental, and social well-being and not just merely the absence of disease of infirmity”-WHO, 1948

  • Descriptive state of health
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Points of Measuring outcomes

Depending on the typ of analysis

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  • CEA
    • Depends on the objectives of the intervention under investigation
    • Final vs. intermediate/ surrogate outcomes
  • CUA
    • Utilities/ Preferences in combination with lifetime
    • Different methods of measurement
  • CBA
    • Preferences in health states are converted into monetary units
    • Different methods of measurement
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Measuring outcomes in CEA

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  • Tends to use clinical outcomes and single dimension reported in their natural units
  • This is appropriate with a major objectives of the therapy 
    • cost per life years gained.
    • Can compare therapies within the medical field
  • Other measures include disease specific outcomes such as symptom free days
    • There must a clear link between intermediate outcome and end point
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TESTE DEIN WISSEN

Definition of: There is a fundamental problem of Scarcity

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Since resources are scarce, choices have to be made about different ways of using them.

Therefore, economics is about choices and decision making.

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Q:

Opportunity cost in the context of healthcare

A:

Opportunity cost is the value placed on the sacrifices, regardless of whether or not money is paid for them.

Given intervention options A and B, How can we make a choice? 

If we choose A, the opportunity cost of choosing A over B is the benefits (value) we forgo had we chosen B.

It is logical that the choice would want to maximise the value received from A and minimise the value of what is given up in B.

Q:

Definition of: 

  • Technical efficiency
  • Allocative efficiency
A:

Technical efficiency 

When considering how to produce any particular good or service, the aim is to achieve the maximum output from available resources, or for a given output, use the least resources possible.



Allocative efficiency

Once goods and services have been produced, the aim is to allocate these to those individuals who will derive the maximum benefit from consuming the goods or service.

Q:

Points of: "Why Economic Evaluation?" 

A:
  • Resources are scarce, need to make choices and minimise opportunity cost.
  • To identify clearly the relevant alternatives.
  • Lets us consider different perspectives of the analysis
  • Allows for quantification of the magnitude of changes in costs and outcomes for competing interventions.
  • Increases the explicitness and accountability in decision-making.
  • Can be Primary or secondary research
Q:

Different Perspectives in Economic Evaluation

A:
  • Individual patients :
    • All patient borne costs
  • Third party payer: Healthcare perspective 
    • Health provider resources only [e.g. Staff costs, prescribed drugs], Insurer, Reimbursements
  • Healthcare and individual patients
    • Patient borne costs and healthcare costs [Patient travel expenses, OTC medicines, hospital costs]
  • Societal perspective 
    • Includes different players in society [e.g. Carer time] and other sector costs [e.g. social costs for time off from work]
Q:

Definition of: 

Time Horizon

A:


how long to measure costs and consequences

  • long enough into the future to capture important differences
    • Disease profile i.e. acute or chronic disease
    • Cost category considered e.g. those within or outside healthcare sector
    • Outcome consideration e.g. intervention removing environmental toxins can have outcomes extending beyond generations


For time horizon beyond 12 months, both costs and consequences must be discounted to show the present value.

Mehr Karteikarten anzeigen
Q:

Definition of: 

Cost analysis

A:
  • Plain evaluation of the costs associated with the intervention under investigation
  • Cannot lead to recommendations or a decision**
  • Can give an idea about the costs of the intervention as part of a health economic evaluation or as a starting point for further research
Q:

Definition of:

Cost of illness

A:
  • Assessment of all costs associated with an illness such as cost of treatment, cost of care, travel time, productivity loss
  • Cannot lead to recommendations or a decision
  • Can be used to assess the economic burden put on society by a certain condition
  • Can be an argument to put more research resources or more attention to a condition (Advocacy)
Q:

Summary of healthcare evaluation:

A:
  • Economic evaluation is used in healthcare to ensure that the addition on new interventions does not displace more health than is gained.


  • To achieve this we need to:
    • Compare costs of the intervention and comparator (incremental costs)
    • Compare benefits of the intervention and comparator (incremental benefits)
    • Calculate the ICER or INB
    • Use the appropriate decision-rule


  • Uncertainty can be incorporated into the results using sensitivity analysis
Q:

Objective of healthcare is to improve population HEALTH

What is health?

A:

“A state of complete physical, mental, and social well-being and not just merely the absence of disease of infirmity”-WHO, 1948

  • Descriptive state of health
Q:

Points of Measuring outcomes

Depending on the typ of analysis

A:
  • CEA
    • Depends on the objectives of the intervention under investigation
    • Final vs. intermediate/ surrogate outcomes
  • CUA
    • Utilities/ Preferences in combination with lifetime
    • Different methods of measurement
  • CBA
    • Preferences in health states are converted into monetary units
    • Different methods of measurement
Q:

Measuring outcomes in CEA

A:
  • Tends to use clinical outcomes and single dimension reported in their natural units
  • This is appropriate with a major objectives of the therapy 
    • cost per life years gained.
    • Can compare therapies within the medical field
  • Other measures include disease specific outcomes such as symptom free days
    • There must a clear link between intermediate outcome and end point
Q:

Definition of: There is a fundamental problem of Scarcity

A:

Since resources are scarce, choices have to be made about different ways of using them.

Therefore, economics is about choices and decision making.

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