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Measuring Costs and Assessing Health Outcomes - Coggle Diagram
Measuring Costs and Assessing Health Outcomes
terminology
opportunity cost
Benefit forgone when selecting one therapeutic alternative over the other
Making decisions based on what gives maximum satisfaction
average cost
Total cost/number of units produced
Changes with number of units produced
incremental cost
Increased cost of one treatment relative to an alternative
includes fixed cost
addtl machine, manpower, raw materials
marginal cost
Change in total cost that results from the production of an additional unit
cost of procurement of raw materials
pertains to
variable cost and raw materials only
fixed cost not included
mortality cost
Cost incurred due to death
Can be direct cost (e.g. medical expenses before px dies) or indirect cost (e.g. economic value like supposed future salary; economic loss due to death)
Example: Cost from reducing the productive age for Filipinos due to premature death
Philippine economic productive age: 15 y/o to 64 y/o
Retirement age: 60 y/o
morbidity cost
Cost incurred due to illness, disability
Can be direct cost (e.g. medical treatment) or indirect cost (e.g. economic loss: salary lost due to absence from work, reduced number of tablets being produced by the worker)
overhead cost
Cost of providing space, power, administrative charges etc.
production cost
Total amount of resources used in producing something.
charges
price charged to a buyer
cost categorization
categorization 1
direct
direct medical
medically related inputs used directly to provide treatment
subgroups
semi-fixed cost
remain unchanged over a range of activity; may increase or decrease
Example: Salary of health workers
variable cost
incurred from a patient's treatment
fixed cost
incurred whether patients are treated or not; capital costs
direct non-medical
costs to patients and their families that are directly associated to treatment but are not medical in nature
indirect
cost that result from the
loss of productivity
because of the illness or death
intangible
value placed on emotional pain and suffering that occur because of an illness or the treatment of an illness
formulas
direct cost
direct medical + non-medical
indirect costs
morbidity costs + mortality costs
total costs
direct costs + indirect costs + intangible costs
categorization 2
health care costs
medical resources consumed by health care entities
similar to direct medical costs but not direct medical costs paid by the patient
costs shouldered by the health care system, not by the patients
other sector costs
costs related to effects or impact on other non-health care sectors such as housing, homemaker services and educational services
patient and family costs
costs to the patient and his/her family without regard to whether costs are medical or non-medical in nature
share of family in direct medical costs + direct non-medical costs
productivity costs
'indirect cost'
salaries last due to loss of productivity and premature death
perspective
an economic term that describes whose costs are relevant based on the purpose of the study
examples
patient
HC provider
payer
society
time-horizon/time frame analysis
period of time during which the outcomes of an analysis will be considered
expressed as a fixed number of years or relative to study variables
suitable for disease and intervention in question
consider if short-term or long-term intervention or treatment
consider if the treatment is comparative to the usual or standard of care and the time when the new treatment would be released
consider the timeframe when to see improvement or effect of treatment
consider economic evaluations
consider the lifespan of treatment or progression of disease
standardization of costs
adjusting for inflation
price in base yr x (CPI current/CPI base yr)
price in base yr x (GDP deflator current/GDP deflator base yr)
adjusting currency changes
currency from other country base yr -> currency in our country base year
adjusting for inflation
discounting
discount factor
multiplier
used to
convert future cash flows into their present value
reflects the time value of money, accounting for the fact that money today is worth more than the same amount in the future due to its potential earning capacity
DF = 1/(1+r)^t
higher DF = long-term interventions appear less cost-effective
present value
current value of a future amount of money or stream of cash flows given a specified rate of return
PV = FV/(1+r)^t = FV*DF
technique used to adjust the value of future costs and benefits to their present value
how are cost measured
resources for cost estimations
literatures
administrative databases
medical records
expert opinion
case report forms
questionnaires
patient diaries
estimating costs
medications
drug price reference index (DPRI)
data on prices of medicines
ceiling price of medicines set by the DOH
average wholesale prices (AWP/ list price/ stic price
average manufacture's price (AMP)
medical services
physicians' fee reference
medicare reimbursement rates
case-rate: fixed reimbursement price set by PhilHealth for each illness
personnel
work measurement rates
productivity loss
hospitalization
least precise
disease-specific per diem
estimated costs per disease per day
diagnostic-related group (DRG)
classify clinically cohesive diagnosis and procedures that use similar resources
how to diagnose and how much is spent on diagnosing
most precise
micro-costing
most precise method of estimating hospital costs
includes all costs throughout
gross costing
not as specific as micro-costing
presentation of cost data
present resource use separately from unit costs
present distribution of costs
report the (arithmetic) mean costs
outcomes
clinical (system-centered clinical outcomes)
factors that reflect the clinical results and performance of therapeutic interventions, services, and products provided by HC professionals and the process or system for delivering that care
measurable changes in health status due to an intervention
evaluated using clinical trials/post-marketing reports
terminal vs intermediate
terminal clincal outcomes
long length of time
difficult to measure the outcome
Ultimate/Final/Endpoint results or events of a disease
Outcomes that typically signify the conclusion or irreversible state of a disease process
examples
Death from a terminal disease,
organ failure,
irreversible injury,
permanent disability
intermediate outcomes
measurable changes that occur before the final end point
examples
Reduction in size of tumor
Decrease in blood pressure in HTN management
Improve lung function in respiratory diseases
humanistic (patient-centered) outcomes
factors that reflect the effect of a therapeutic product or service has on how patients perceive their health status and satisfaction with care
functional health status
patient's current health state, including both physical and mental wellness, as affected by any underlying diseases or medical conditions
assesses the effect that a therapy or service has on the patient's abiiity to perform usual daily activities at home or at work
focuses on health aspect
quality of life
an individuals perception of their position in life in context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns
assess how patients perceive and react to their health status and to the non-medical aspects of life
EQ5D5L
measures QoL on 5 component scale: mobility, self-care, usual activities, pain/discomfort, anxiety/depression
focuses on nonhealth aspect
economic (cost) outcomes
finance-related resources needed to provide HC service and products to patients
expressed in terms of expense, savings, or cost avoidance
measure opportunity cost
pharmacoeconomic varables
measurable entities
categorical
numerical
measured by
deterministic value
reflection of 1 observation or an explicit asignment of value
specific, fixed value
example: price of medicine
probabilistic value
reflection of multiple observations of the value
rage, not specific
example: effectiveness of paracetamol
variables
economic variables
measures of economic cost of the disease and disease management process
direct medical
direct nonmedical
indirect
resource utlization
frequencies or counts of the resources used in the disease management process
Example: How many times were the medications taken?
monetary valuation
economic value of each unit of resource consumed
Placing a monetary value for each count or frequency
Example: A patient visits a doctor for “n” times and each visit is ₱500.00
clinical variables
measures stick against which health improvement is gauged
specifics of the disease process dictate varibles used for measuring clinical outcomes
types
patient-specific
typically referred to as the patient's characteristics or demographics
Example: age, gender, weight
disease-specific variable
employed to characterize different aspects of the disease state
Ex. diabetes -> blood glucose levels
risk modifier
clincal factor that impact predispostion to disease sequelae, disease progression or responsiveness to tx
Example: Possible diseases that a heavy smoker can get: lung cancer, etc.
humanistic variables
how do you measure your satisfaction
utility
a way of expressing patiet's preferences existing in a given state of health
the unit of satisfaction
quality of life
A way of ranking state of health and his level of functioning in the state of health