Question: Firstatin costs $20 per 5 mg pill once daily; Secondstatin costs $7 per 10 mg pill three times daily. Efficacy and side-effect profiles are similar. Which drug is more cost-effective?

Answer Options: • A. Firstatin costs more but results in better clinical outcomes, thus is more cost-effective • B. Secondstatin is dominated by Firstatin • C. Given different doses, the drugs cannot be compared • D. Secondstatin is more cost-effective • E. Drugs have same cost-effectiveness

Answer: B

Question: TITLE: “Cost-minimization comparison of treatments with Cholestyramine and Crestor for Secondary Prevention of MI for the Third-Party Payer” Are assumptions stated and reasonable?

Answer Options: • A. Yes. The authors clearly stated all of their assumptions. • B. Yes. The authors stated that there were no assumptions. • C. No. The authors did not explicitly state many of their assumptions. For example, what percent of the patients were adherent to their medication? • D. None of the above

Answer: C

Question: Was the conclusion unbiased and supported by the results and methods of the study? Why or why not?

Answer Options: • A. No. The choice of an old generic drug that doesn’t work very well is suspect. • B. No. The conclusion that one drug provides the “best value” is unfounded considering only two drugs were compared. • C. No. Charges and AWP were used and were not an accurate reflection of costs so results may be biased. • D. No. Cost-minimization ignores the important differences in effectiveness. • E. All of the above

Answer: E

Question: There are two drugs for the treatment of cancer. Drug X costs $8,000 and improves survival by 5 years while Drug Y costs $3,000 and improves survival by 15 years. Both have the same side-effect profile. Which drug is considered cost-effective and is the best alternative?

Answer Options: • A. DrugX dominates DrugY and therefore is the cost-effective alternative. • B. The cost-effectiveness ratio is –$1,000 per life-year saved so the answer would depend on whether or not the evaluator believes the extra cost is worth the extra health benefit. • C. DrugX is dominated by DrugY. • D. We cannot determine this from the information given.

Answer: C

Question: There are two drugs for the treatment of cancer. Drug X costs $3,000 and improves survival by 20 years while Drug Y costs $3,000 and improves survival by 15 years. Both have the same side-effect profile. Which drug is considered cost-effective and is the best alternative?

Answer Options: • A. DrugX dominates DrugY and therefore is the cost-effective alternative. • B. The cost-effectiveness ratio is –$5,000 per life-year saved so the answer would depend on whether or not the evaluator believes the extra cost is worth the extra health benefit. • C. DrugX is dominated by DrugY. • D. We cannot determine this from the information given.

Answer: A

Question: Treatment with Drug X and Drug Y both extend patients’ median survival by one year. Drug X costs $300 and Drug Y costs $100. The drugs are in the same class, have the same efficacy, but slightly different side-effect profiles. Is cost-minimization appropriate, and which drug is least expensive overall?

Answer Options: • A. No. The increase in survival is the same but there are differences in adverse effects so cost-minimization is not appropriate. Although Drug Y costs less, cost-utility analysis would be better because it would include the impact of adverse effects on quality of life. • B. Yes. The outcomes are different so cost-minimization is appropriate and is the best type of pharmacoeconomic analysis in this case. Drug X and Drug Y result in the same cost overall. • C. Yes. The outcomes are the same so cost-minimization is appropriate. Drug Y is the least expensive treatment overall. • D. No. There are differences in median survival time so cost-minimization is not the best type of pharmacoeconomic analysis. Cost-effectiveness analysis would better capture the differences in cost per life-year saved. • E. None of the above

Answer: A

Question: A 70-year-old man breaks his hip in a fall caused by drug-induced orthostatic hypotension. He now pays maids to clean his house and make his meals, tasks he once did himself. What type of cost is this?

Answer Options: • A. Direct medical • B. Direct nonmedical • C. Indirect • D. None of the above

Answer: B

Question: TITLE: “Cost-minimization comparison of treatments with Cholestyramine and Crestor for Secondary Prevention of MI for the Third-Party Payer” Was the perspective of the study clearly stated?

Answer Options: • A. Yes. The authors clearly state that the study was done from the hospital perspective. • B. Yes. The authors clearly state that they use medical claims. • C. No. Although the authors state that they used hospital charges, they do not clearly state the perspective of the study. • D. None of the above

Answer: D

Question: TITLE: “Cost-minimization comparison of treatments with Cholestyramine and Crestor for Secondary Prevention of MI for the Third-Party Payer” Is a clear objective stated?

Answer Options: • A. No. The objective does not state the perspective of the study. • B. No. The objective does not declare the specific type of study and does not pose a well-defined question in an answerable form. • C. Yes. The objective specifies the type of study and treatments involved. • D. Yes. The objective poses a well-defined question and is aligned with the study conducted.

Answer: C

Question: TITLE: “Cost-minimization comparison of treatments with Cholestyramine and Crestor for Secondary Prevention of MI for the Third-Party Payer” Was a comprehensive description of the competing alternatives given?

Answer Options: • A. No. The authors did not discuss why they did not use other types of pharmacoeconomic analyses (cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis). • B. No. The authors did not discuss the dosages used or the assumption about how adherent patients were to the drugs. • C. Yes. The authors clearly described the two competing

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