SL22109 - EBP (copy)

What is EBP

Evidence Based Practice: the conscientious, explicit (can show others easily) and judicious use of the current best evidence in helping individual patients make decisions about their care in the light of their personal values and beliefs

What is CMA?

Cost-Minimisation Analysis

• Simplest

• Assumes the benefit of interventions are equal

• Compare the costs and choose the cheaper one

What is CCA?

Cost-Consequence Analysis

• Measure costs and benefits of your two analysis

• Show as table to compare

• Reader/decision maker must make their own judgement on which intervention is better

What is the Cost-Effectiveness Plane?

Costs on Y-axis and Benefits on X-axis as a cross plane graph (like the CAST rap fm A-Level maths)

Plot based on which is better in each of those categories

Anything in the bottom right quadrant is best treatment as better for cost and effectiveness

What is CEA?

Cost-Effectiveness analysis

• We consider cost benefits to health service and effectiveness in patient but not in the wider society

• calculate based on costs differences due to each additional unit of benefit

• Use ICER equation

ICER = (C1 – C0)/ (E1 – E0) where units are £ per whatever the benefit is (e.g. per extra year in life or per heart attack avoided)

C1 and E1 are costs and effects (benefits of “new drug”") in a study intervention group

C0 and E0 are costs and effects (benefits) in a study control group

What is CUA?

Cost-Utility Analysis - ICERs cannot be compared if the benefits have different units

• subtype of CEAs where benefits are all measured as QALYs so you can then compare the £ for each extra QALY

• results are compared and treatments with lower QALYs are funded

• This method is used by NICE and it usually uses a cost-effectiveness threshod of £20,000-£30,000 per QALY

ICER = (C1 – C0)/ (E1 – E0)

C1 and E1 are costs and QALYs in a study intervention group

C0 and E0 are costs and QALYs in a study control group

What is CBA?

Cost-Benefit Analysis

• typically uses societal perspective

• measures costs and benefits of two interventionss

• benefits are used in monetary terms using various methods to get an average of how much the public are willing to pay for certain benefits

• not often used because it's difficult to complete

What are the four types of analysis?

• Cost-minimisation analysis (CMA)

• Cost-consequence analysis (CCA)

• Cost-effectiveness analysis (CEA)

  • Cost-utility analysis (CUA)

• Cost-benefit analysis

What are the two main methods of carrying out economic evaluation?

Economc Modelling:

• Decision tree model

• Markov model

What are the two types of ways of carrying out economic evaluation?

• Analysis

• Economic Modelling

What is technology appraisal?

Review the clinical and cost-effectiveness of new treatments and then NS is required to fund approved treatments within 3 months

What are the types of technology appraisals?

Single technology:

• Clinical and economic evidence is supplied by the manufacturer

• Evidence group then review and critique the evidence

Multiple technologies:

• evidence is generated by technology assessment group

How is the technology appraisals different for End of Life treatment?

Tratment is indicatedfor patient with short life expectancy

What are highly specialised technology appraisals?

• Single technology for a single, very rare indication (<500 people in England)

• For key, new and emerging technologies

• ICER threshold depends on incremental QALYs gained per person:

  • <10 QALYs gained: £100,000 per QALY

  • 11-29 QALYs gained: £100,000-300,000 per QALY

  • •>30 QALYs gained: £300,000 per QALY

Define Economic Evaluation

Comparison of two or more alternative treatments in terms of costs and benefits. It always:

• Measure differences in costs (resources need to deliver healthcare)

• Measure differences in benefits (the consequences of this healthcare)

And then quantifies trade-offs between alternative treatments. The EE is the framework for rational decision making to ensure maximum utility from scarce resources

What is utility?

Resources such as land and labour are scarce so the act of maximise your satisfaction. This is called utility.

Define health economics?

The study of attempts to allocate limited health care resources among unlimited wants and needs to achieve the maximum health benefit for society

We look into:

• How much resource should we devote to healthcare?

• Within a fixed health budget, how do we choose which treatments to provide (prioritisation)?

• How do the ways we pay for healthcare affect efficiency?

Define pharmacoeconomics

The application of the theories, techniques and concepts of health economics to the study of pharmaceutical interventions

How does perspective affect health economics?

The point of view adopted when deciding which types of costs and benefits are included in an economic evaluation. The perspectives are based on:

• Healthcare system: only costs and benefits relevant to the healthcare system

• Society: costs and benefits to the whole of society, e.g. the healthcare system, the patient, the wider economy etc

What are the main costs that affect economic evaluation?

• Direct medical costs

  • staff time

  • medicines and dressings

  • equipment and facilities

• Direct patient costs

  • time costs

  • time off work

• Indirect costs

  • productivity changes

What are the main benefits that affect economic evaluation?

Health effects:

• Life years gained

• QALYs

• Cases successfully treated

Economic effects:

• Direct benefits (savings)

• Indirect benefits (production gains)

What are QALYs?

Quality-adjusted life-years = number of years lived x quality of life

One number that considers two things:

• How long someone lives after treatment (years)

• Their quality of life for this time measured on a scale from 0 to 1

  • 0 = death

  • 1 = full health

What is the I² equation in heterogeneity?

% of chi-squared not explained by variation studies so the lower the number the smaller the heterogeneity

I^{2 =} 100 x (chi² - df)/ chi²

What are Cochrane reviews?

Type of a systematic review:

• Taking all papers on a particular topic and then doing one large review on ALL of them and used as a definitive review

• Incredibly reliable but easier to read summary since they’re so long and detailed

How do we consider the changes in population when measuring the frequency of the disease?

• By calculating the incidence

What are PPPs?

Pregnancy Prevention Plans

Some specific small number medicines have high evidence to suggest that they are highly teratogenic when used in pregnancy but the benefits of treatment cannot be replaced so PPPs are needed to ensure pregnancy does not occur e.g. Isotretanoin/Valporate