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Chapter 72. Cost-Effectiveness in Interventional Cardiology

What is the most common method used for cost-effectiveness analysis?

A. Sensitivity analysis

B. Incremental cost-effectiveness ratio

C. Bootstrap analysis

D. Markov analysis

E. Health utility assessment

The correct answer is B

Incremental cost-effectiveness ratio (ICER) is the most widely used and accepted method to evaluate cost-effectiveness of a particular intervention. Authors have found that ICER has been used in the majority of studies as a fundamental metric evaluating cost-effectiveness of a new therapy. The ICER is defined as the incremental cost of providing a specific intervention or therapy divided by the incremental gain in the health benefit. ICER is usually compared to a standard willingness-to-pay threshold, eg, $50,000/life-year gained.

What quadrant of cost-effectiveness plane is considered most cost effective?

A. Upper right

B. Upper left

C. Lower right

D. Lower left

The correct answer is C

The cost-effectiveness plane (CEP) is a 2-dimensional display of incremental effectiveness versus incremental cost where the x-axis represents incremental cost of a new therapy compared to the conventional therapy and the y-axis represents incremental effectiveness of the new therapy compared to the standard treatment. Thus, points on the plane represent a graphical display of the ICER. The CEP is divided into 4 quadrants. The lower right quadrant is the most cost effective since it introduces more effective newer treatment strategies at a lower cost than the standard treatment option. Such newer therapies are known as “dominant” therapies over standard treatment.

What is the concept used in Markov decision-analytic model?

A. Projection of cost per life-year or quality-adjusted life-year (QALY) gained based on short-term results

B. Projection of 10-year cost per QALY gained based on 2-year results

C. Projection of health utility changes after short-term intervention

D. Projection of long-term survival based on short-term results

The correct answer is A

The duration of many clinical trials is usually not long enough for an accurate estimation of the long-term course of a clinical disease. This limits the accurate estimation of the changes in life-years and QALYs with a newer therapy and thus incremental gain in life-years or QALYs over standard therapy. Therefore, the cost-effectiveness analysis based on ...

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