The
methodical instruction
For
practical LESSON of the student
Lesson
#2 (6
hours)
Theme: Costs and cost determination. Decision Modeling Techniques. Markov Modeling in Decision
Analysis
The purpose: familiarize yourself with the types
of pharmacoeconomic costs and methods
of their determination. Familiarize yourself with the
features of calculations the cost of treating
the disease. Definition of analysis "decision tree" and its importance for pharmacoeconomic studies. Use principles
of simulation-based decision
tree "for and obtain results
that confirm the effectiveness of drugs and
justify the cost of using
them.
Vocational counselling of students:
Health economics is a branch of economics concerned with issues related
to efficiency, effectiveness, value and behavior in the production and
consumption of health and health care. In broad terms, health economists study
the functioning of the health care systems as well as
health-affecting behaviors such as smoking.
Students’
Independent Study Program
1.1 Basic concepts
1. 2 Cost classification
2.1 Decision Modeling Techniques
2.2 Decision Modeling Paradigm
2.2.1 Types of Decision Modeling Techniques
2.2.2 Decision Trees
2.2.2.1 Steps in Conducting a Decision Analysis
2.2.2.2 Step 1: FRAME the Question
2.2.2.3 Step 2: STRUCTURE the Clinical Problem
2.2.2.4 Step 3: Estimate the PROBABILITIES
2.2.2.5 Step 4: Estimate the VALUES of the Outcomes
2.2.2.6 Step 5: ANALYZE the Tree (Average Out/Fold Back)
2.2.2.7 Step 6: TEST ASSUMPTIONS (Sensitivity Analysis)
2.2.2.8 Step 7: INTERPRET the Results
2.2.3 Markov Models
2.2.4 Simulation Models
2.2.4.1 Microsimulation
2.2.4.2 Discrete Event Simulation
2.2.4.3 Agent-Based Simulation
2.2.5 Deterministic (Mechanistic) Models
2.2.6 Summary of Modeling Types
2.3 Example
2.3.1 Step 1: Framing the Question
2.3.2 Step 2: Structuring the Clinical Problem
2.3.3 Step 3: Estimate the Probabilities
2.3.4 Step 4: Estimate the Values of the Outcomes
2.3.5 Step 5: Analyze the Tree
2.3.6 Step 6: Test Assumptions (Sensitivity Analysis)
2.3.7 Step 7: Interpret the Results
4.1 Markov Modeling in Decision Analysis
4.2 The Markov Process and Transition Probabilities
4.2.1 Stochastic Processes
4.2.2 Markov Processes
4.2.2.1 Transition Probabilities
4.2.2.2 Working with a Transition Probability Matrix
4.2.3 Absorbing Markov Models
4.2.3.1 Behavior of the Absorbing Model
4.2.3.2 Use of Absorbing Markov Models in Clinical Decision Analysis
4.3 Markov Model Example: Cervical Cancer
Practical
work (9.00 - 12.00)
TECHNIQUE
OF PERFORMANCE OF PRACTICAL WORKS
Work 1. Write the cost classification. Results show in the
table.
|
Name |
Determination |
Example |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Work 2. Make division of expenses for treatment of
the patient with stroke
|
Direct medical |
Direct non-medical |
Indirect |
|
|
|
|
A. Delivering the patient
to the clinic
by personal transport
B. Costs
of diagnosis
1.
CBC
2.
urinalysis
3.
computed tomography of the brain
4.
blood chemistry
B. Costs
of outpatient treatment
1.
cost of hospital
stay
2.
cost-time of medical staff
3.
cost of drugs
4.
costs of auxiliary material
G.
costs of outpatient treatment
C. Costs
of diet
D.Cost of patient time
E. Additional therapy
1.
massage
2. physiotherapy
Work 3. To calculate direct
medical costs of treatment in
hospital patients with gastric ulcer.
|
Medical expenditures |
Manufacturer |
Price |
Expenditures, 1 UAH. for 1 patient per
day |
Total expenditures for cource treatment |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
Work 4. To calculate the
direct non-medical costs to the
patient with gastric ulcer.
Work 5. Calculate the cost of
treating a patient with myocardial infarction, including inpatient, outpatient treatment.
1. Delivery of the patient
to the hospital
with ambulance
2.
|
Diagnosis |
Cost |
Number |
|
CBC |
5 UAH |
4 |
|
Blood chemistry |
10 UAH |
2 |
|
Urinalysis |
3 UAH |
4 |
|
ECG |
10 UAH |
5 |
3. Costs for
hospital treatment
The cost of
hospital stay - 40 UAH.
The cost of
drugs -
Cost-time medical staff
- 18 UAH.
The cost of
supporting materials -
4. The cost
of rehabilitation period
5. Expenses for outpatient treatment
6. Meals
7. Cost-time patient - 35 UAH.
8. Supplemental therapy: physical therapy, drug therapy
aimed at preventing repeat of heart attacks.
Work 6. The use of antiaggregants new generation - Plavix for the prevention
of myocardial infarction, stroke is more efficient,
safer than traditional antithrombotic drug - tiklid. But the high
retail price of Plavix limits
its use in
general medical practice. With the construction of a "decision tree" evaluate the feasibility of Plavix to
prevent the above complications in the cardiovascular
system, given the likelihood of agranulocytosis (as a side effect
of treatment). For calculations, use the following
data:
• The degree of likelihood
of agranulocytosis in patients with
treatment by Plavix - 0.4;
• The degree of likelihood
of agranulocytosis in patients with
treatment by tiklid - 0.7;
• The degree of probability
of the absence
of agranulocytosis in patients with
treatment by Plavix - 0.6;
• The degree of probability
of the absence
of agranulocytosis in patients with
treatmentby tiklid
- 0.3;
• The costs of pharmacotherapy
by Plavix is
450 UAH;
• The costs of pharmacotherapy
by tiklid is 190 UAH.
• Costs for treatment of
agranulocytosis is 210 UAH.
Seminar discussion of theoretical
questions and practical work - 12.30
– 14.00
Initial level of knowledge and abilities – 14.15 – 15.00
9. Students must
know:
10. Students
should be able to:
1. Give the pharmacoeconomic evaluation of medications
and treatments.
2. Searching information
sources.
The author: Truhybchak
O.V.
It is approved on faculty meeting
on .
Protocol #