This document provides an overview of cost-utility analysis (CUA) as a form of pharmacoeconomic evaluation. It defines CUA and distinguishes it from cost-effectiveness analysis by noting that CUA compares outcomes in terms of quality-adjusted life years (QALYs). The document discusses how QALYs combine both survival time and health-related quality of life into a single metric. It also describes approaches to measuring health utility values and calculating QALYs. Finally, the document provides examples of when CUA would and would not be appropriate to use and outlines factors like incremental cost-utility ratios used to interpret CUA results.
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Declaration: The materials incorporated in this document have come from variety of sources and compiler bears no responsibilities for any information contained herein. The compiler acknowledges all the sources although references have not been explicitly cited for all the contents in this document.
various measures for the measurement of outcome such as incidence prevalence and other drug us measures are briefly discussed here with suitable examples and equations
Pharmacoeconomics is a branch of health economics which compares the value of one drug or a drug therapy to another.
By understanding the principles, methods, and application of pharmacoeconomics, healthcare professionals will be prepared to make better decisions regarding the use of pharmaceutical products and services.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
breif notes on what is pharmacoepidemiology, why do we need pharmacoepidemiology, whats is its aim and its main applications, advantages and disadvantages
Statistical softwares used in pharmacoeconomics @ RxVichuZ!! :)RxVichuZ
This summarized outline deals with SOFTWARES USED IN PHARMACOECONOMIC STUDIES, their precise details, merits & summarized relevant applications.
With respect to PHARMACOEPIDEMIOLOGY & PHARMACOECONOMICS subject.
In this presentation i have tried to explain in detail about the measurements of the outcomes which are used in epidemiology such as prevalence, incidence, fatality rate, crude death rate etc.
Pharmacoeconomics is a branch of health economics which compares the value of one drug or a drug therapy to another.
By understanding the principles, methods, and application of pharmacoeconomics, healthcare professionals will be prepared to make better decisions regarding the use of pharmaceutical products and services.
Definition and scope of Pharmacoepidemiology ABUBAKRANSARI2
In these slides I shared the information of definition and scope of pharmacoepidemiology. Types of studies - cohort studies, cross-sectional studies etc.
breif notes on what is pharmacoepidemiology, why do we need pharmacoepidemiology, whats is its aim and its main applications, advantages and disadvantages
Statistical softwares used in pharmacoeconomics @ RxVichuZ!! :)RxVichuZ
This summarized outline deals with SOFTWARES USED IN PHARMACOECONOMIC STUDIES, their precise details, merits & summarized relevant applications.
With respect to PHARMACOEPIDEMIOLOGY & PHARMACOECONOMICS subject.
In this presentation i have tried to explain in detail about the measurements of the outcomes which are used in epidemiology such as prevalence, incidence, fatality rate, crude death rate etc.
CUA is a formal economic technique for assessing the efficien
cy of healthcare interventions. It is
considered by some to be a specific type of cost effectiveness analysis in which the measure of
effectiveness is a utility or preference adjusted outcome.
The process of healthcare is undertaken so that people can benefit from the intervention. An economic evaluation looks at all the implications of deciding to choose one way of providing care over another, not just the costs. This means that any effect the service, good or bad, has on the patient or customer needs to be investigated
Valuing health states associated with chronic disorders of consciousness shah...Office of Health Economics
This presentation reviews current methods for capturing how the general public values health states as background for discussion on applying these to chronic disorders of consciousness.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. Lecture Outline
1. What is CUA?
– Definition
– When to use it
– When not to use it
2. Outcome Measure
– Uni-dimensional
– Multi dimensional
• DALY
• QALY
3. Approaches for Health State valuation
3. Introduction
• Apart from economic aspects, PE evaluations may also focus on
humanistic concerns.
• For pharmacotherapy decisions.
– various factors like patient preferences, patient satisfaction, impact of disease and
Rx of disease on a patient's health related QOL are applied in PE.
• QOL : the assessment of functional effects of illness and its consequent
therapy as perceived by the patient.
• expressed as emotional, physical or social impacts on patients
• QOL can be measured with the help of structured questionnaires filled by
patients.
4. Cost-utility analysis/CUA
• CUA is a special form of cost-effectiveness analysis (CEA)
– both in CUA and CEA we are interested in the incremental costs and incremental
consequences between alternatives.
– It is similar to the CEA, except that it includes societal and/or patient preferences to
adjust outcomes, such as additional years of life saved
• The difference between the 2 methods lies in the nature of the
outcomes compared.
– In CUA, the numerator of (ICER) is a measure of cost (similar to other forms of CEA)
and the denominator is measured typically using a metric called the quality-
adjusted life year (QALY).
– In CEA compares alternatives based on a common clinical effect
5. CUA…
Utility
• is expressed as the number of life years saved adjusted to account
for loss of quality or for disability (QALYs or DALYs)
• Numerical estimate of quality of life (QOL) associated with a
disease state or treatment
– e.g., per quality-adjusted life year (QALY) gained
• A QALY accounts for both survival and quality of life (QoL) benefits associated
with the use of a healthcare technology. Health utility
• In CUA the outcomes measure that is used to compare
alternatives is one that combines both the quality and quantity of
life. QALYs is the most commonly used in CUA
6. CUA…
How to determine utility?
• by asking actual patients to assign utility weights to their own health status.
• by asking people who do not have the disease to think about a hypothetical
situation and then assign utility weights to the state of health described in the
scenario.
How to measure utility?
• rating scales, the Standard Gamble method, or the Time Trade-off method.
• a numerical value between 0 and 1 is identified, with 0 being the worst health
and 1 being the best health.
• Anything else…somewhere in between
• Measured using questionnaires
subjectivity of the assessment
7. CUA…
• Allows comparison of different health interventions
– Provision of antiretrovirals (ARVs) for HIV-infected persons VS prevention of mother-to-child
transmission (PMTCT)
– Provision of ARVs Vs Polio vaccination
– migraine pharmacotherapy VS angioplasty
• compare cost, quality, and the quantity of patient-years
• policy makers and reimbursement agencies.
– With ICER thresholds from which to judge whether a drug or healthcare technology is CE
– UK : £30,000 per QALY gained ;
– USA: $50,000 per QALY gained
– WHO: ICER < 3X per capita gross domestic product (GDP) for a given country
8. CUA…
• When to use CUA
– Health-Related Quality of Life is THE important outcome
– Programmes affect both mortality and morbidity and you want
to combine both effects
– Programmes affect wide range of outcomes and you want
common unit for comparison
9. CUA…
• When not to use?
– Only have intermediate outcome data
– Effectiveness data show outcomes are equivalent
– Effectiveness data show dominance
– Extra cost of obtaining utility values is itself not CE
(requires judgment on whether doing so would change result)
10. Outcome Measures
• Defining the outcome of interest
– One-dimensional
– Multi-dimensional
• Measures changes in health taking into account fatal and
non fatal health outcomes
• Includes DALY and QALY
12. Outcome Measures... Life Years
• Life Years
– Simplest and widely used measure of health
– Used when the dominant gain from a change is
extra life rather than relief of pain or disability
13. Outcome Measures... DALY
Disability Adjusted Life Years (DALY)
• Includes
– potential years of life lost due to premature death (YLL) and
– equivalent years of health life lost by virtue of being in state other than
good health (equivalent healthy years lost due to non fatal condition)
DALY = YLL + YLD
• The non fatal health outcomes
• are difficult to define
• contain various domain like mobility, anxiety, pain etc.
14. Outcome Measures... DALY
DALY calculation
– Calculate years of life lost due to each disease
– Calculate loss of quality of life of those living with each
disease
– Apply weights to reflect social value of people at different
ages
– Apply discount rate
15. Quality Adjusted Life Years (QALY)
• the number of years of perfect health.
• Life expectancy adjusted based on utility
• Two basic outcomes of health care
1. mortality
– Mortality benefit expressed as life-years gained
2. HRQL
HRQL measurement
• described in terms of the ‘health state’
• single value
• 0 (death) - 1 (good health) scale
Outcome Measures... QALY
16. • all of the health benefits (i.e., quality and length of life)
• the sum of all of these adjusted health states over the planning
horizon
• is the product of the length of life (e.g., the additional years of life gained by
taking a drug) and the patient’s assessment of the quality of health during
that period of time, or the utility of the health status, to which people
in this field refer.
• QALY = utility X life years gained
• QALY = utility of state X time in health state
• Combine morbidity and mortality data
Outcome Measures... QALY
17. Calculating QALy
• Advantage over CEA:
– it can combine more than one measure of effectiveness or
– both measures of mortality and morbidity into a single measure
• DAvd:
– absence of agreement in measuring utilities,
– lack of standards for comparing QALY and
– problems with the quantification of patient problems.
• Reserved for comparing programs and treatment alternatives
whose basic goal is improving QOL.
18. Calculating QALy
• In order to calculate QALY we need two pieces
of data
– The path of the health states and the duration of the health
states over the time span for which QALY are to be calculated
– The preference weight for health states for the same
duration
19. Generic Disease Specific
Quality of Well Being (QWB) Asthma Quality of Life
Questionnaire
-Health Utilities Index (HUI)
-Euro Qol (EQ-5D)
QALY Measurement
Outcome Measures...
21. Exercise 1
• Suppose you have drug Y and drug X. Suppose that you knew
that the QoL of people living with the disease that these drugs
treat is relatively poor.
• If the research has shown the utility value for this health status
to be 0.3.
• Drug Y saves 6 years of life and Drug X saves 5 years of life
• With this information, calculate the QALYs associated with each drug and
interpret both by utility value and health status ??
22. Exercise 1 …
• For Drug Y
– Utility value= 0.3
– Number of years of life saved= 6
QALY = 0.3 x 6 = 1.8 years
How do you interpret this result???
23. Exercise 1 …
Interpretation:
• drug Y achieve the equivalent of 1.8 years of life at a
utility of 1
or
• drug Y achieve the equivalent of 1.8 years of life of the
best possible health.
24. Exercise 1 …
• Once you have calculated the QALYs for drugs Y and X,
• You can now determine the incremental difference in the costs
and outcomes, or incremental cost utility ratio (ICUR).
Suppose, The ICUR in this example is ETB 80,000:1,
how do you interpret this ICUR????
25. Exercise 1 …
ETB 80, 000:1, ICUR means that
You would have to spend an additional 80,000 ETB for drug Y
over drug X to achieve one additional QALY.
How do you see this cost? Is it excess of the benefit gained?
26. Exercise 2
Suppose, a patient suffer from disease ‘X’ and has been receiving Drug therapy
‘A’ which has a survival benefits of 10 years. If the patients is left untreated,
the patient will only live for 5 years. Estimated utility value (relative to
‘perfect health’) with drug therapy ‘A’ and without therapy is 0.7 and
0.5respectively. The cost incurred by the patient with drug therapy ‘A’ and
without therapy A is 18,000ETB and 4,000ETB respectively.
Calculate QALY with and without treatment?
Calculate ICUR and interpret your result?
27. Exercise 3
• Suppose you are a ward pharmacist of oncology clinic at hospital
X in Ethiopia. in your hospital you have been using Drug A as a
standard of care and now, the new chemo drug is to be
considered for procurement by the hospital. both chemo drugs
prolong life and both cause side effects which reduce QOL. Your
standard chemo (Drug A) prolongs life by 1 year and reduce QoL
of your patients by 35% due to its side effects. The new chemo
prolongs life by 1.5 years at estimated utility value of 0.5.
You are requested to perform a PE analysis which is CUA.
Calculate the QALYs for each chemo drugs??
28. Exercise 3…
Standard chemo (Drug A)
• Life expectancy = 1year
• Utility values = 1-0.35= 0.65
• QALYs = 1 x 0.65= 0.65 years
– The new treatment is expected to add 0.65 quality-adjusted life-years to
your patient’s life.
New chemo
• Life expectancy = 1.5 years
• Utility value = 0.5
• QALYs = 1.5 x 0.5 = 0.75 years
– The new treatment is expected to add 0.75 quality-adjusted life-years to
our patient’s life.
29. Exercise 3…
• Suppose a full course of treatment costs of both
chemos are as follows,
– 1,200 ETB for standard Chemo
– 1,500 ETB for new Chemo
• Calculate ICUR?
• Interpret your result?
30. Exercise 3…
• ICUR = cost of new chemo- cost of standard chemo
QALYs of new chemo - QALYs of standard chemo
= 1,500ETB – 1,200ETB = 3,000 per QALYs
0.75- 0.65
Interpretation:
On average, it costs us 3,000 ETB to add one year of perfect
health onto the life of your patient.
So is this considered cost-effective?
31. Exercise 3…
Suppose, Ethiopia’s per capita GDP is 400 USD?
So, can the new chemo be considered as cost-
effective?
Based on WHO recommendation.
32. Exercise 3…
• WHO recommendation is < 3x per capita GDP of ICER to judge
whether a given drug therapy or health technology is CE or not.
– So, as for this case your ICUR is 3,000 Per QALYs
– And the per capita GDP is 400 x 20 = 8,000
From this date the new chemo may be considered CE
but at a higher price.
33. Exercise 4
Assume, Drug therapy ‘X’ increases one’s life expectancy
by 2 years, but causes adverse effects or
inconvenience, such that one’s QoL or utility are
decreased by 25%.
Calculate QALYs with treatment?
34. Exercise 5
Duration Health
State
Weight
3 months Hospital
Dialysis
.62
3 months Home
confinement
for TB
.68
8 years Home Dialysis .65
8 years Mastectomy
for breast CA
.48
1. Sketch the QALY diagram
and determine how
many QALY are gained if
a person achieves an
eight year life extension
on home dialysis under
assumption of no
discounting and 5%
discounting
35. Exercise 5
2. Sketch the QALY diagram and determine how many
QALY are gained if a person achieves a three month life
extension on hospital dialysis
a. No discounting b. Discounting rate of 5%
36. Exercise 5
3. Assume a breast cancer patient will become symptomatic, have a
mastectomy and live additional six years. By screening you can
detect the breast cancer one year earlier and add two years to
the patients life(now she lives nine years from the mastectomy
instead of six) Sketch the QALY diagram and determine how many
QALY are gained by screening
a. Assuming no discounting b. Assuming 5% discount rate
37. Example 6
Presbyopia affects most people at age 40 years. It does not affect
life expectancy but diminish visual functions. After vision
declines at age 40, it does not (hypothetically) decline more with
advancing age. There is anew surgical procedure for this
condition that restore vision to normal with no complication
and costs $ 10,000. Life expectancy at age 40 in the general
population is assumed to be 42 years and time trade off yields a
utility value of 0.999 for presbyopia. Calculate the number of
QALY with intervention and without intervention
39. 3. Methods of Measuring Preference
• Example: EQ-5D (EuroQol 5 dimensions; n=245)
• Health state 1:
• no problems walking about; no problems with self care;
no problems performing usual activities; no pain or
discomfort; not anxious or depressed
• Health state 2:
• no problems walking about; no problems with self care;
some problems performing usual activities; no pain or
discomfort; extremely anxious or depressed
40. 3. Methods of Measuring Preference
• Classifies patients according to four attributes
• Mobility
• Physical Activity
• Social Activity
• Symptom Problem Complex
Quality of
well Being
(QWB)
• Five attributes
• Mobility
• Self Care
• Usual Activity
• Pain/ Discomfort
• Anxiety/depression
Euro Qol(EQ
5D)
41. Summary
• There is no expected effect of the intervention on
mortality: physical, social and psychological wellbeing
are the expected effects of the intervention
• Both morbidity and mortality are affected by the
intervention and a common metrics is desired
• Interventions with a range of different outcomes will
be compared
Situations where QALYs should be used or might be useful
42. Summary
• When only intermediate outcome data can be
obtained and these outcomes cannot be converted
into QALYs
• When obtaining utility measure is too expensive or
too difficult
• When incorporating utility measures would not
change conclusions
Situations where QALYs may not be useful or should not be used
Editor's Notes
various factors like patient preferences, patient satisfaction, impact of disease and treatment ofdisease on a patient's health related QOL are applied to pharmacotherapy decisions.
both CUA and CEA compare alternatives based on a common outcome, and in both forms of analysis we are interested in the incremental costs and incremental consequences between alternatives.
is similar to the CEA, except that it includes societal and/or patient preferences to adjust outcomes, such as additional years of life saved.CUA adds adjustment factors that recognize that the value of an additional life year will be different if a patient spends that year ill in a nursing home than if the individual spent the year as a healthy community-dweller.
Of course there are problems with these methods, which primarily stem from the subjectivity of the assessment. For example, one person’s definition of the worst state of health may be very different from that of a different person’s definition.
reserved for comparing programs and treatment alternatives whose basic goal is improving QOL.Because QALYs and other utility measures are highly subjective,there is some disagreement among researchers regarding which scales should be preferred for measuring utility.
The most common measure is MOS SF-36, which provides a general measure of functioning and well being and is used often since it has been validated in many populations and is widely accepted,
In the case of drug Y, we achieve the equivalent of 1.8 years of life at a utility of 1 (or the best possible health).
In the case of drug Y, we achieve the equivalent of 1.8 years of life at a utility of 1 (or the best possible health).
CUA is expressed in a ratio called cost utility ratio (C/U ratio). This ratio is often translated as the cost per QALY obtained.
In fact, many experts in this area consider a threshold of $50,000 per QALY to be the cut-off point, above which the cost is in excess of the benefits gained. Like the ICER, however, the point where one is no longer willing to pay the additional cost for the outcome gained can be very personal and subjective
Drug A 0.7 x 10 = 7Without Rx 0.5 x 5 = 2.5ICUR = 3,111 per QALY
the net gain is 2 x 0.75 = 1.5 QALYs
When estimating a QoL weight, the range of potential values for a given health state are usually bounded by 0 and 1, where 1 corresponds to best imaginable health and 0 corresponds to death.There is some debate over whether benefits can also be discounted (it is relatively easy to accept that £100 spent now is worth more than in five years time, but how does one compare a healthy year now to a healthy year in five years time?)
Condition in which an elderly person’s sight fails gradually, through hardening of the lens