Cost effectiveness and pharmacoeconomics

Cost minimization assumption and support what decision?

Assume equivalent outcomes

What equivalent option costs less?

Generic atorvastatin vs brand lipitor, therapeutic equivalents

IF ONE OPTION DIFFERS IN OUTCOME< then CMA can be misleading

Cost effectiveness analysis/CMA assumption and support what decision?

Natural events: events avoided, life years

What is extra cost per clinical gain

Cost/hospilization avoided

Clinical utilit Analysis assumption and support what decision?

Quality adjusted life years

What is extra cost per QALY

Cost /QALY for MS therapy

Cost benefit analysis assumption and support what decision?

Benefits valued in moeny

Is monetary benefit> cost

Monetary vaccinatino benfefit vs costs

Cost of illness/Budget impact models assumption and support what decision?

Disease burden/budget expenditure

how large is burden/adoption budget?

Annual burden of uncontrolled asthma

3 year formulary adoption impact for BIM

Time horizon description

choose meaningful horizon: shorter if uncertain about benefits

Discounting rate and formula

Present value=future value/(1+r)^t

Apply stated rate to future cost, which is 3% based on US second panel reference

SHows that future is worth less than we think

ICER formula REMEMBER

Delta Costs/Delta Effects

(C one-Ctwo)/ E one-Etwo

Cost effectiven analysis deeper description

Compares cost+health outcomes of alt intervention to inform decisions about use of limited healthcare resources

Cost effectiveness plane 4 quadrants and Threshold rate?

Have a threshold rate/willingness to pay that you wanna stay below, as below that is cost effective

Quad 1:/Trade off/Top Right: higher cost+more health

Other trade off is quad 3/bottom left, lower cost: less health

Quad 2 and 4 are dominant (- sign of ICER)

Quad IV (top left: Higher cost and less health BAD)

Quad 2: bottom right: lower cost, mor ehealth, NICE

CUA (Cost Utility Analysis) better description and QALY equation?

Form of CEA that compare costs and health outcomes of alt interventions measured in QALY

QALY=time in health state * utility (preface/questionnares)

if 1.0: then anchor=full health, if 0 then is death, want to be somewhere between those two for utility.

Thresholds and limits of ICER

Lambda=Value /opportunity cost threshold/health unit

For northeast result, compare ICER with delta/threshold unit

Ratios become unstable when delta effect is near zero, and negative ICer gotta explain it

Incremental Net monetray benefit equation

Lambda*DeltaQALY- Delta Cost

Shows is it actually worth much?

decision tree vs markov model

Decision tree: comes from 1, and ends at 1, have EXPLICIT BRANCHES

Markov model: you can move between stages of health such as chronic or acute or remission

1 way vs scenario vs PSA for uncertainty: what changes for each and what tells reviewer?

1 way: one input ovre justified range: whicih input drives result? (helps figure out what is strongest factor)

Scenario: Alt structure/assumpsion: singly or together: Would plausible alt change conclusion? (how does cost or output change over time or over certain factors?)

PSA: Prob sensitivity analysis: joint draws form uncertain input distribush: how uncertain is value at a sttaed threshold (how do two diff alts change as you increase cost, does willingness to pay change?)

Cost effective acceptability curve

At each lambda, count modeled draws with POSITIVe incremental net benefit

Probability depends on model, inputs and threshold,

Doesn't show size of gain/losses