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HiYield Paper B

Started on Wednesday, 20 May 2020, 11:49 AM

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Question 1 HiY ResearchMethods 127

Not answered An economic analysis was conducted to determine the relative cost-
effectiveness of three classes of antidepressants: tricyclic
Marked out of 1
antidepressants (TCAs), selective serotonin reuptake inhibitors
Flag question (SSRIs), and the modified TCA Lofepramine (LOF) as first choice
treatments for depression in primary care. [Peveler, R., et al. (2005).
A randomised controlled trial to compare the cost-effectiveness of
tricyclic antidepressants, selective serotonin reuptake inhibitors and
Lofepramine]. Using the below graph answer the following
questions. In this context, the acronym QALY is most likely to
indicate

Select one:
Quality Approximated Life Years

Quantity of Actual Life Years

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 Quantity Acceptable for Lending Years

Quality Adjusted Lender's Yield

Quality Adjusted Life Years

Check

Your answer is incorrect.

QALY refers to quality-adjusted life-year. It is obtained by computing
the mathematical product of life expectancy and a measure of the
quality of the unspent (remaining) life-years. Rapley, M. (2003).
Quality of life research: A critical introduction. Sage.
The correct answer is: Quality Adjusted Life Years

Question 2 HiY ResearchMethods 128

Not answered An economic analysis was conducted to determine the relative cost-
effectiveness of three classes of antidepressants: tricyclic
Marked out of 1
antidepressants (TCAs), selective serotonin reuptake inhibitors
Flag question (SSRIs), and the modified TCA Lofepramine (LOF) as first choice
treatments for depression in primary care. [Peveler, R., et al. (2005).
A randomised controlled trial to compare the cost-effectiveness of
tricyclic antidepressants, selective serotonin reuptake inhibitors and
Lofepramine]. From the below graph answer the following
questions. If a sum of £50,000 is invested on the provision of TCAs,
then the probability that this investment has contributed to a gain in
1 QALY is

Select one:

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 20%

0.7

30%

0.2%

60%

Check

Your answer is incorrect.

In the attached graph, the continuous line refers to TCAs. Along the
x axis, we can see that £50,000 per QALY equates to a point of 0.2
along the y axis for the TCA curve. The value 0.2 is same as a 20%
probability for achieving an acceptable cost-effectiveness at the
cost specified.
The correct answer is: 20%

Question 3 HiY ResearchMethods 129

Not answered An economic analysis was conducted to determine the relative cost-
effectiveness of three classes of antidepressants: tricyclic
Marked out of 1
antidepressants (TCAs), selective serotonin reuptake inhibitors
Flag question (SSRIs), and the modified TCA Lofepramine (LOF) as first choice
treatments for depression in primary care. [Peveler, R., et al. (2005).
A randomised controlled trial to compare the cost-effectiveness of
tricyclic antidepressants, selective serotonin reuptake inhibitors and
Lofepramine]. From the below graph answer the following
questions. The attached graph is known as

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 Select one:
Cost Effectiveness Plane

Kaplan Meier Curve

Cost Effectiveness Acceptability Curve

Cost Effectiveness Analysis Curve

ICER graph

Check

Your answer is incorrect.

A cost-effectiveness acceptability curve (CEAC) is a method to
represent uncertainty associated with economics of health
interventions. It is frequently used to present the results of a cost-
effectiveness analysis
The correct answer is: Cost Effectiveness Acceptability Curve

Question 4 HiY ResearchMethods 130

Not answered An economic analysis was conducted to determine the relative cost-
effectiveness of three classes of antidepressants: tricyclic
Marked out of 1
antidepressants (TCAs), selective serotonin reuptake inhibitors
Flag question (SSRIs), and the modified TCA Lofepramine (LOF) as first choice
treatments for depression in primary care. [Peveler, R., et al. (2005).
A randomised controlled trial to compare the cost-effectiveness of
tricyclic antidepressants, selective serotonin reuptake inhibitors and
Lofepramine]. From the below graph answer the following
questions. According to the graph presented here, which is the most
effective antidepressant?

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 Select one:
MAOI

SSRI

Lofepramine

TCA
None of the above

Check

Your answer is incorrect.

Using a cost-effectiveness acceptability curve, we cannot compare
the efficiacy or effectivenss of various interventions; we can only
infer the relative probabilities associated with acceptable cost-
effectiveness for various interventions.
The correct answer is: None of the above

Question 5 HiY ResearchMethods 131

Not answered An economic analysis was conducted to determine the relative cost-
effectiveness of three classes of antidepressants: tricyclic
Marked out of 1
antidepressants (TCAs), selective serotonin reuptake inhibitors
Flag question (SSRIs), and the modified TCA Lofepramine (LOF) as first choice
treatments for depression in primary care. [Peveler, R., et al. (2005).
A randomised controlled trial to compare the cost-effectiveness of
tricyclic antidepressants, selective serotonin reuptake inhibitors and
Lofepramine]. From the below graph answer the following

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 questions. You are informed that the National Institute for Clinical
Excellence (NICE) operates with a readiness to spend
approximately £30,000 per QALY. In this case, which of the
following conclusion is valid?

Select one:
SSRIs are likely to be acceptably cost-effective.

Lofepramine is likely to be acceptably cost-effective.

A 100% probability for cost-effectiveness of SSRIs can be

achieved

There is no apparent difference in the cost-effectiveness of the

three drugs
TCAs are likely to be acceptably cost-effective.

Check

Your answer is incorrect.

Among the 3 curves, at a level of £30,000 investment, the highest
probability of being cost effective is seen for the SSRI curve. Hence
SSRIs are the most likely choice for being cost-effective
interventions if one can spend £30000 for a QALY gained. If the
willingness to pay per QALY is considerably lower, say <£5000,
other drugs may appear to be better choices (esp. lofepramine).
The correct answer is: SSRIs are likely to be acceptably cost-
effective.

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 Question 6 HiY ResearchMethods 132
Not answered An old age psychiatry service in Liverpool compared the costs of
running domiciliary clinic vs. running an outpatient clinic for all initial
Marked out of 1
referrals over four years. It was concluded that over four years the
Flag question cost of running a domiciliary clinic was 500,000£ while the cost for
the outpatient clinic was 579,000£. What type of study is this?

Select one:
Cost consequences

Cost minimisation

Cost effectiveness

Cost benefits
Cost utility

Check

Your answer is incorrect.

Cost minimisation studies are used when both interventions
produce same outcome; hence just the costs are compared.
Outcomes are assumed to be the same and are not compared. For
example consider the following: Which will cost me less- Buying
CLOZARIL or buying ZAPONEX (another brand of clozapine)?
Clozaril may be £3.5 per tablet vs. zaponex £3.11 per tablet.
The correct answer is: Cost minimisation

Question 7 HiY ResearchMethods 133

Not answered An RCT compared the effectiveness of using co-prescribed heroin
vs. sole prescription of methadone in heroin users. An associated
Marked out of 1
economic analysis concluded that there was a gain of at least 0.5
Flag question QALY per patient per year of treatment, and the cost saved was
around 6000£ per patient per year of treatment. What type of study
is this?

Select one:
Cost utility
Cost benefits

Cost consequences

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 Cost minimisation

Cost effectiveness

Check

Your answer is incorrect.

Cost-utility study is used when instead of clinical effect (measured
using scales, questionnaires, bed occupancy etc) as .an outcome
one holistically considers the disease burden, side effects and
social impact etc., Here the outcome is measured in QALYs or
DALYs.
The correct answer is: Cost utility

Question 8 HiY ResearchMethods 134

Not answered Which of the following is an appropriate study design to compare
two different interventions with different clinical outcomes in terms
Marked out of 1
of monetary outcomes?
Flag question

Select one:
Cost minimisation
Cost effectiveness

Cost consequences

Cost utility

Cost benefits

Check

Your answer is incorrect.

When two different interventions with different clinical outcomes are
compared wherein all outcomes are translated into monetary (£s)
terms for comparison, then this study is called cost-benefit study. It
is often used by managers to decide how to spend the allocated
money effectively.
The correct answer is: Cost benefits

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 Question 9 HiY ResearchMethods 135
Not answered In an attempt to study the cost of adherence vs. non-adherence to
treatment in depression treated at primary care centres, an
Marked out of 1
investigator calculates the costs of illness in terms of the costs for
Flag question hospitalization, GP-visits, specialist referral, cost of medications,
and cost of each day of sick leave due to depression. Which of the
following among the above can be called an indirect cost?

Select one:
Cost of specialist referral

Cost of medications

Cost of hospitalisation

Cost of GP visits
Cost of sick absence

Check

Your answer is incorrect.

Direct costs: Cost of hospital space, cost of drugs, equipments,
salary of doctors and other professionals etc. Indirect costs: Costs
due to loss of productivity for the patient, cost of having a caretaker
for one's dog or a nanny for one's child when hospitalised etc.
Intangible (not measurable) costs: Pain and suffering, social stigma,
physical discomfort, etc.
The correct answer is: Cost of sick absence

Question 10 HiY ResearchMethods 136

Not answered 615 adult patients were asked at baseline interviews and six-month
follow-up interviews how much they would be prepared to spend per
Marked out of 1
month for a six-month treatment that would eliminate their
Flag question symptoms of depression. This measure is called

Select one:
Per capita purchasing power
Average cost measure

Willingness to pay

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 Incremental cost effectiveness measure

Standard gamble measure

Check

Your answer is incorrect.

Willingness to pay (WTP): How much people would be prepared to
spend to prevent or cure a particular health state? Time trade-off
measures: how many of the remaining life years would a
respondent spend in trying to get cured of a particular condition
(inversely - how important is it for some one to get relief from a
problem). Standard gamble measures: Imagine there is a risky
intervention for a health state that can either cure if successful or kill
if it fails. How much risk will an individual take to get cured off such
a condition with such an intervention? The measures are given as
odds of success vs. odds of death - the respondents are asked to
choose their preferred values.
The correct answer is: Willingness to pay

Question 11 HiY ResearchMethods 137

Not answered A Fast Track Intervention programme has been introduced by
Ministry of Justice to reduce juvenile crimes. There has been no
Marked out of 1
intervention available to prevent juvenile crime before this was
Flag question introduced. It is estimated that when 100 students are inducted into
the programme at a cost of 12,000£ per student, four juvenile
criminal events are reduced. The incremental cost-effectiveness
ratio for the fast track programme is given by

Select one:
£120 per criminal event

Insufficient information to calculate ICER

£3,000 per criminal event

£300,000 per criminal event

£12,000 per criminal event

Check

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 Your answer is incorrect.
The most popular economic evaluation method in health care is
Cost effectiveness analysis. The results of a cost-effectiveness
analysis can be summarised either as average cost-effectiveness
ratio (ACER) which is equal to cost/effect or as incremental cost-
effectiveness ratio (ICER), which is a measure of the additional cost
per unit of health gained. ICER = [Cost of proposed intervention -
cost of control intervention.] divided by [ Effect of proposed
intervention - effect of control intervention.] Here, there is no control
intervention. So ICER will be = Cost of proposed intervention / effect
of proposed intervention. = (12,000 X 100) / 4 = 300,000 per
criminal event
The correct answer is: £300,000 per criminal event

Question 12 HiY ResearchMethods 138

Not answered Which of the following is not a subtype of sensitivity analyses?

Marked out of 1
Select one:
Flag question
One way analysis

Worst case scenario measures

Time trade off measures

Bootstrapping measures
Monte Carlo simulations

Check

Your answer is incorrect.

Various assumptions are usually made in an economic analysis. For
example one assumes a standard inflation, discounts for money
values changes in the market etc., when calculating costs. (Note
that conventionally 6% discount rates are assumed). So it is
pertinent to check the effect of the outcome of such economic
analysis by systematically examining what will happen if the
assumptions are changed in some way. This sensitivity analysis can
be done in various ways such as one-way, worst case scenario,

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 Monte-Carlo, bootstrapping, etc. Time trade-off measure is not a
sensitivity analysis; it is a proxy measure of health state
preferences.
The correct answer is: Time trade off measures

Question 13 HiY ResearchMethods 139

Not answered Dr. Hidalgo, a popular poet, comes to your clinic with significant
adjustment reaction. He is worried about being a poet and not
Marked out of 1
practicing medicine. He wonders how much money he has lost by
Flag question not practicing medicine. Which of the following terms best suits the
economic loss he might have concurred?

Select one:
Intangible cost

Opportunity cost
Direct cost

Indirect cost

Healthcare cost

Check

Your answer is incorrect.

Opportunity cost refers to the cost of wasted opportunities - i.e. cost
of losing an opportunity to attend a business meeting, having
attended a dental appointment. Every action has an opportunity
cost.
The correct answer is: Opportunity cost

Question 14 HiY ResearchMethods 140

Not answered Which of the following two parameters are required for constructing
a cost-effectiveness analysis curve?
Marked out of 1

Flag question Select one:

Willingness to pay and probability of cost effectiveness

Willingness to pay and QALYs gained

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 ICER and clinical symptom rating scale scores

ICER and QALYs gained

Probability of cost effectiveness and QALYs gained

Check

Your answer is incorrect.

A decision maker / NHS manager will be interested to know how
sure he/she can be in probabilistic terms to make an investment.
This probability can be identified from the incremental cost-
effectiveness plane with reference to the decision maker's defined
maximum acceptable ceiling ratio using Cost effectiveness
acceptability curve - CEAC. The CEAC indicates the probability that
an intervention is cost-effective compared with the alternative, given
the observed data, for a range of lambda (Willingness to Pay)
values. The CEAC is a method for summarizing the uncertainty in
estimates of cost-effectiveness.On one side of the curve, probability
of cost effectiveness is plotted; on the other side willingness to pay
(for decision maker) is plotted (Retrieved from
http://www.biomedcentral.com/1472-6963/6/52).
The correct answer is: Willingness to pay and probability of cost
effectiveness

Question 15 HiY ResearchMethods 141

Not answered In a cost-effectiveness plane which of the following quadrant
indicates best cost effectiveness of an intervention?
Marked out of 1

Flag question Select one:

Southwest

Northeast

Southeast
Northwest

Central

Check

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 Your answer is incorrect.
The incremental cost and incremental effect can be represented
visually using the incremental cost-effectiveness plane. The
horizontal axis divides the plane according to incremental cost
(positive above, negative below) and the vertical axis divides the
plane an according to incremental effect (positive to the right,
negative to the left). This divides the incremental cost-effectiveness
plane into four quadrants through the origin Each quadrant has a
different implication for the decision. ICER falls in NORTHWEST:
Positive costs and negative effects - no use of the intervention.
ICER falls in SOUTHEAST: Negative costs and positive effects -
intervention is preferred. ICER falls in NORTHEAST: Positive effects
and positive costs - needs further consideration before acceptance.
ICER falls in SOUTHWEST: Negative costs and negative effects -
not clinically effective - needs further study (Retrieved from
http://www.biomedcentral.com/1472-6963/6/52).
The correct answer is: Southeast

Question 16 HiY ResearchMethods 142

Not answered In a nationally funded study, respondents are asked to consider a
choice between undergoing ECT and living with severe depression.
Marked out of 1
The odds of relief from depression and developing amnesia when
Flag question undergoing ECT are varied to see at what point the respondent
considers ECT is not a worthy option. This study is best described
as

Select one:
Time trade off measurement

Cost minimisation study

Health preference rating study

Standard gamble measurement

Cost effectiveness study

Check

Your answer is incorrect.

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 Standard gamble is "a method of establishing the utility of a
specified health state. For chronic health states, people are asked
to choose between the certainty of the specified health state for a
given period of time or a gamble that involves a probability (p) of
restoration to full health and a complementary probability (1-p) of
immediate death. The value of p is changed until the respondent
regards the two options as equivalent to each other. The utility of
the specified health state is then given by p. A slightly modified
method is needed for temporary health states or states regarded as
worse than death". Shiell, A., Donaldson, C., Mitton, C., et. al
(2002) Health economic evaluation. J Epidemiol Community Health,
56, 85-88.
The correct answer is: Standard gamble measurement

Question 17 HiY ResearchMethods 143

Not answered Which of the following types of economic analyses could be
completed when one has access only to cost data and not outcome
Marked out of 1
data?
Flag question

Select one:
Cost utility analysis

Cost effectiveness study

Cost benefit analysis

Cost minimisation analysis

Cost consequences analysis

Check

Your answer is incorrect.

Cost minimisation analysis is a specific type of cost-effectiveness
analysis in which the outcomes of the two (or more) comparators
are assumed equal, thereby resulting in an assessment based
solely on comparative cost. Making the assumption of equal
outcomes can be risky, as such assumptions rarely hold in practice.
Shiell, A., Donaldson, C., Mitton, C., et. al (2002) Health economic
evaluation. J Epidemiol Community Health, 56, 85-88.
The correct answer is: Cost minimisation analysis

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 Question 18 HiY ResearchMethods 144
Not answered Which of the following two parameters are required for constructing
a cost-effectiveness analysis curve?
Marked out of 1

Flag question Select one:

Willingness to pay and QALYs gained

ICER and clinical symptom rating scale scores

Willingness to pay and probability of cost effectiveness

ICER and QALYs gained

Probability of cost effectiveness and QALYs gained

Check

Your answer is incorrect.

The cost-effectiveness acceptability curve (CEAC) illustrates the
uncertainty surrounding the estimate of cost- effectiveness. A CEAC
shows the probability that an intervention is cost-effective compared
with the alternative, given the observed data, for a range of
maximum monetary values that a decision-maker might be willing to
pay for a particular unit change in outcome.
http://bjp.rcpsych.org/content/187/2/106.full
The correct answer is: Willingness to pay and probability of cost
effectiveness

Question 19 HiY ResearchMethods 145

Not answered You review a trial which measures monetary costs and
consequences of psychotherapy. What term best describes the
Marked out of 1
costs of lost productivity to patients and their employers as a
Flag question consequence of attending treatment?

Select one:
Discounter cost
Indirect cost

Direct Cost

Marginal cost

Intangible cost

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 Check

Your answer is incorrect.

Indirect costs or productivity losses are the labour earnings that are
forgone as a result of an adverse health outcome. The decreased
productivity can be a result of illness, death, side effects, or time
spent receiving treatment. Indirect costs include lost earnings and
productivity of both patients and the family members who take care
of them. For some diseases with premature death, the indirect cost
is the loss in potential wages and benefits. Indirect costs associated
with premature death might be very high.
The correct answer is: Indirect cost

Question 20 HiY ResearchMethods 146

Not answered Zarkin et al., 2008 reported a cost effectiveness comparison of
naltrexone and placebo in alcohol abstinence. The mean
Marked out of 1
effectiveness measured as percentage days of abstinence was
Flag question nearly 80% for naltrexone group while it was 73% for the placebo
group. The mean cost incurred for the placebo group was $ 400 per
patient. The naltrexone group incurred a cost of $ 680 per patient.
How much additional cost needs to be spent per patient for each
percentage point increase in total days of abstinence when using
naltrexone compared to placebo?

Select one:
$ 500

$ 50

$7

$ 40

$2

Check

Your answer is incorrect.

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 To calculate ICER that is asked in this question, first calculate total
effectiveness gained. It is 7% extra days of abstinence. This has
come at a cost of extra 280 per patient. So the ICER = 280/7 = 40
USD per percentage days of abstinence
The correct answer is: $ 40

Question 21 HiY ResearchMethods 147

Not answered Cost Benefit Analysis is an economic evaluation technique that
includes which of the following measurements?
Marked out of 1

Flag question Select one:

Clinical evaluation of healthcare investments

Costs of not undertaking the second best alternative

Economic evaluation in terms of clinical effect

Analysis of the benefits in terms of quality of life

Economic evaluation in monetary terms

Check

Your answer is incorrect.

Cost Benefit Analysis (CBA) is an economic evaluation technique
that measures all the positive (beneficial) and negative (costly)
consequences of an intervention or program in monetary terms. The
valuation of all program outcomes in monetary units allows
decision-makers to directly compare the health outcomes of
different types of health interventions.
The correct answer is: Economic evaluation in monetary terms

Question 22 HiY ResearchMethods 148

Not answered An economist is interested in assessing the benefits foregone by a
particular use of health resources. This can be termed as
Marked out of 1

Flag question Select one:

Cost effect

Inflation rate

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 Direct cost

Benefit ratio

Implicit costs

Check

Your answer is incorrect.

Benefits forgone by a particular use of resources is known as
opportunity cost. A commonly used method to evaluate the
opportunity cost of health resources is to estimate the indirect costs
of the next best alterative that could have been put in place with the
same resources. This is often an implicit cost not directly incurred
by the health providers. BMJ. 1999 Jun 5;318(7197):1551
The correct answer is: Implicit costs

Question 23 HiY ResearchMethods 149

Not answered In economic analysis which of the following represents the cost of
pain and suffering from an intervention that cannot be quantified in
Marked out of 1
monetary terms?
Flag question

Select one:
Intangible costs

Baseline costs

Opportunity costs

Indirect costs

Incremental costs

Check

Your answer is incorrect.

Indirect cost refers to the costs of an intervention that is not directly
due to the intervention itself, but can be quantified in units other
than currencies e.g. number of sick days off work when undertaking
a hysterectomy. The term intangible cost is used to describe the
costs of pain and suffering that cannot be quantified. Opportunity

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 cost refers to the cost of a hypothetical loss when a choice is made
between two options. For example, the opportunity cost suffered by
a brilliant high school student when he becomes a doctor is the
money that was not earned from being a solicitor. Incremental cost
refers to the additional cost of providing an intervention over and
above an existing intervention.
The correct answer is: Intangible costs

Question 24 HiY ResearchMethods 150

Not answered A retrospective cohort study was used to measure inpatient service
utilization in 63 consecutive treatment resistant schizophrenia
Marked out of 1
patients started on clozapine from a geographical catchment area
Flag question compared to a control group matched for previous inpatient service
use. An intent-to-treat analysis, including those patients (n = 28)
who discontinued clozapine during the study period, showed a
significant reduction in number of admissions and total time spent in
hospital in the 2 years following clozapine initiation compared to the
previous 2 years and to the follow-up period in the control group. In
terms of economic outcomes, the whole clozapine group (n = 63
includes both continuers and discontinuers) had a mean reduction
of 33 bed days over the 2-year period following initiation of
clozapine. In terms of local costs (£220 per adult mental health bed
day, excluding capital costs), this translates into a reduction of
£7341.40 in hospitalization costs per clozapine patient over the 2-
year period. In those patients who continued clozapine treatment for
the whole of the 2-year period (continuers), there was a two-thirds
reduction in number of admissions and total time spent in hospital
compared to no change in the clozapine discontinuers. [Hayhurst
KP et al. The cost-effectiveness of clozapine: a controlled,
population-based, mirror-image study. Journal of
Psychopharmacology 16(2) (2002) 169 –175]. Whose viewpoint has
been used to measure the costs?

Select one:
Society's viewpoint

Pharmaceutical companies' viewpoint

Patients' viewpoint

Service providers' viewpoint

Carers' viewpoint

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 Check

Your answer is incorrect.

The costs were calculated based on factors such as bed days and
hospitalisation costs. It was not based on the patient's loss of
productivity or carer's costs, or societal burden. Thus, the
computation has taken the viewpoint of hospital managers.
The correct answer is: Service providers' viewpoint

Question 25 HiY ResearchMethods 151

Not answered A retrospective cohort study was used to measure inpatient service
utilization in 63 consecutive treatment resistant schizophrenia
Marked out of 1
patients started on clozapine from a geographical catchment area
Flag question compared to a control group matched for previous inpatient service
use. An intent-to-treat analysis, including those patients (n = 28)
who discontinued clozapine during the study period, showed a
significant reduction in number of admissions and total time spent in
hospital in the 2 years following clozapine initiation compared to the
previous 2 years and to the follow-up period in the control group. In
terms of economic outcomes, the whole clozapine group (n = 63
includes both continuers and discontinuers) had a mean reduction
of 33 bed days over the 2-year period following initiation of
clozapine. In terms of local costs (£220 per adult mental health bed
day, excluding capital costs), this translates into a reduction of
£7341.40 in hospitalization costs per clozapine patient over the 2-
year period. In those patients who continued clozapine treatment for
the whole of the 2-year period (continuers), there was a two-thirds
reduction in number of admissions and total time spent in hospital
compared to no change in the clozapine discontinuers. [Hayhurst
KP et al. The cost-effectiveness of clozapine: a controlled,
population-based, mirror-image study. Journal of
Psychopharmacology 16(2) (2002) 169 –175]. Which of the
following is most likely to be a weakness of this economic analysis?

Select one:
The use of 2-years of follow-up rather than restricting follow-up
within a single financial year

The recruitment of both exposed and unexposed cohorts from

the same geographical catchment

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 The use of a treatment resistant sample as opposed to first
episode sample

The use of an intention-to-treat analysis in a cohort study

The use of clinical effectiveness data obtained from a non-

randomised sample

Check

Your answer is incorrect.

When we compare effectiveness of two measures, we prefer using
a RCT design. In the same way, when we compare the costs of two
approaches, it is best to derive the cost data from a randomised
sample. Note that economic analysis itself is NOT a study design.
The correct answer is: The use of clinical effectiveness data
obtained from a non-randomised sample

Question 26 HiY ResearchMethods 152

Not answered A retrospective cohort study was used to measure inpatient service
utilization in 63 consecutive treatment resistant schizophrenia
Marked out of 1
patients started on clozapine from a geographical catchment area
Flag question compared to a control group matched for previous inpatient service
use. An intent-to-treat analysis, including those patients (n = 28)
who discontinued clozapine during the study period, showed a
significant reduction in number of admissions and total time spent in
hospital in the 2 years following clozapine initiation compared to the
previous 2 years and to the follow-up period in the control group. In
terms of economic outcomes, the whole clozapine group (n = 63
includes both continuers and discontinuers) had a mean reduction
of 33 bed days over the 2-year period following initiation of
clozapine. In terms of local costs (£220 per adult mental health bed
day, excluding capital costs), this translates into a reduction of
£7341.40 in hospitalization costs per clozapine patient over the 2-
year period. In those patients who continued clozapine treatment for
the whole of the 2-year period (continuers), there was a two-thirds
reduction in number of admissions and total time spent in hospital
compared to no change in the clozapine discontinuers. [Hayhurst
KP et al. The cost-effectiveness of clozapine: a controlled,
population-based, mirror-image study. Journal of

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 Psychopharmacology 16(2) (2002) 169 –175]. The average
incremental effectiveness gained by clozapine users as opposed to
non-clozapine users in this study is

Select one:
16.5 bed days per year

2/3rd reduction in number of admissions

£220 per adult mental health day

£3670.70 per year

£231,254.10 per year

Check

Your answer is incorrect.

Note that this question asks you what the difference in
effectiveness, not the ICER. The results suggest that on average,
clozapine group have 33 additional bed days 'saved' in 2 years.
This translates to saving 33/2 = 16.5 bed days per year. This value
is the incremental effectiveness.
The correct answer is: 16.5 bed days per year

Question 27 HiY ResearchMethods 153

Not answered A retrospective cohort study was used to measure inpatient service
utilization in 63 consecutive treatment resistant schizophrenia
Marked out of 1
patients started on clozapine from a geographical catchment area
Flag question compared to a control group matched for previous inpatient service
use. An intent-to-treat analysis, including those patients (n = 28)
who discontinued clozapine during the study period, showed a
significant reduction in number of admissions and total time spent in
hospital in the 2 years following clozapine initiation compared to the
previous 2 years and to the follow-up period in the control group. In
terms of economic outcomes, the whole clozapine group (n = 63
includes both continuers and discontinuers) had a mean reduction
of 33 bed days over the 2-year period following initiation of
clozapine. In terms of local costs (£220 per adult mental health bed
day, excluding capital costs), this translates into a reduction of
£7341.40 in hospitalization costs per clozapine patient over the 2-
year period. In those patients who continued clozapine treatment for

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 the whole of the 2-year period (continuers), there was a two-thirds
reduction in number of admissions and total time spent in hospital
compared to no change in the clozapine discontinuers. [Hayhurst
KP et al. The cost-effectiveness of clozapine: a controlled,
population-based, mirror-image study. Journal of
Psychopharmacology 16(2) (2002) 169 –175]. . The total reduction
in the cost of hospitalisation in clozapine users as opposed to non-
clozapine users in this study is

Select one:
£3670.70 per year

2/3rd reduction in number of admissions

£220 per adult mental health day

£3630 per year

£231,254.10 per year

Check

Your answer is incorrect.

This question tests the concept of ICER. ICER is given by
difference in costs / difference in effectiveness. This value has
already been given, for a two-year period, for each patient on
clozapine (£7341.40). For 63 patients, this will translate to 63 X
£7341.40 = £ 462508.2. But this is the ICER for 2 years. For one
year, this will be £462508.2/2 = £231,254.10 per year.
The correct answer is: £231,254.10 per year

Finish review

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