HTA (Midterms)

• Factors Affecting Cost Management:

  
  

  • Global Competition
  • Growth of Service Industry
  • Advances in Information Technology
  • Advances in Management Environment
  • Computer-integrated Manufacturing
  • Consumer Orientation
  • New Product Development
  • Total Quality Management
  • Time as a Competitive Element
  • Efficiency
• Type of Cost Category:

  • Direct Medical Costs
  • Direct Non-medical Costs
  • Indirect Costs
  • Intangible Costs
• Indirect Cost

  • Loss of productivity for patient.
  • Loss of productivity for unpaid caregiver.
  • Loss of productivity because of premature mortality.
• Bringing Past Costs to the Present: Costs Standardizations

  
  

  • Cost Adjustment - required when costs are calculated based on data obtained for more than a year prior to the study.
  • Retrospective Data - if used to measure used resources over a period of time, costs should be adjusted or valued at a single point in time.
• Bringing Future Costs to the Present: Discounting - account for costs and benefits that occur at different times.
• Resources for Cost Estimations

  • Medications
  • Medical Services
  • Personnel Costs
  • Hospitalizations
• Four Methods of Estimating Hospital Costs:

  • Micro-costing
  • Disease-specific per diem
  • Diagnosis-related group
  • Per dium
• Outcomes are the end results of medical care.
• Measuring Clinical Outcomes: Relative Treatment Effect

  • Physiological Measures and Clinical Events
  • Survival
  • Quality of Life
• Disease-specific measures focus on dimensions of the patient's QoL related to a particular condition.
• Generic measures of HRQoL do not focus on particular diseases rather on the general dimensions of health such as depression, pain, mobility, etc.
• Utility

  • Generic measure that can be used to compare outcomes across different patient groups and disease areas.
  • Defined as the "value a person places on a particular health state or health outcome."
• Standard Gamble - preferred by health economists because it is based on making choices and taking risks.
• Time horizon is the "length of time over which costs and consequences are assessed."
• A particular model may be analytical, visual, or both.
• Pharmacoeconomic Modeling Method

  • Decision Tree
  • Markov Model
• Decision Trees - outlines and quantifies the consequences of the two or more options of a decision to be made.
• Outcomes are depicted at the end of each pathway (terminal node).
• Markov states represent the cost and utility of spending one cycle in that state.
• Calculation Methods

  • Monte Carlo Simulation
  • Cohort Simulation
• In-direct Nursing Cost

  • Cost used by the hospital to provide service to patients.
  • Include building and capital equipment use, occupancy services, departmental, faculty, and central administration, library operations, and technical services, and cost of operations.
• Cost-push Theory of Inflation - suggests that higher prices result from the rising costs within the healthcare business.
• The Levels of Cost Hierarchy

  • Unit-level Cost
  • Batch-level Cost
  • Business-level Cost
  • Enterprise-related Cost
• Batch-level Cost - include all the supporting services that are performed from admission through discharge.
• Cost-effectiveness Analysis - form of economic evaluation in which health gains from an intervention are evaluated relative to their costs.
• For Independent Interventions:

  Average C/E ratio = Cost/Effectiveness
• Decision Making:

  • Increasing Cost
  • Increasing Effectiveness
  • Decreasing Cost
  • Decreasing Effectiveness