Question: Is the type of study stated? Is this study type appropriate?

Answer Options: • A. Yes. The authors clearly state that the study is a cost-minimization analysis and this is the appropriate type of study for this comparison because one of the drugs is an inexpensive generic. • B. No. The authors do not state explicitly the type of study but the methods do appear to be appropriate within the context of the study question because there is an inexpensive generic drug available. • C. No. The authors do not state the type of study and the study does not appear to be appropriate because there is a difference in mean LDL reduction. • D. Yes. The type of study is stated but it is not the appropriate study for this comparison because the authors show that there is a difference in effectiveness. • E. None of the above.

Answer: D

Question: Was adjustment or discounting appropriate/necessary? If so, was it conducted?

Answer Options: • A. No. Adjustment and discounting were not necessary because the study lasted only one year and they did not discuss using costs from the past or any events or costs that accrue in the future. • B. No. Adjustment and discounting were not appropriate because the authors used the Average Wholesale Price and the cost-to-charge ratio. • C. Yes. Adjustment and discounting were necessary but the authors did not conduct it. • D. Yes. Adjustment and discounting were necessary because the authors used DRG charges for hospital costs and therefore they should have used a cost-to-charge ratio. • E. None of the above.

Answer: A

Question: Whose costs would be included in a pharmacoeconomic study conducted from the 3rd-Party Payer perspective?

Answer Options: • A. Societal costs • B. Patient costs • C. Costs paid by the insurance company • D. A and B • E. A and C

Answer: C

Question: What is the best type of pharmacoeconomic study to compare Firstatin and Secondstatin?

Answer Options: • A. Cost-minimization • B. Cost-utility • C. Cost-of-illness • D. Cost-effectiveness • E. None of the above

Answer: D

Question: Was the title appropriate? Why or why not?

Answer Options: • A. Yes. The title declares what is actually studied. • B. Yes. The title declares the type of study, treatments and provides the perspective of the study. • C. No. The title declares the type of study and treatment but is not specific about the condition studied. • D. No. The title does not declare the type of study or the treatments compared. • E. None of the above.

Answer: C

Question: What type of pharmacoeconomic study is this (asthma drugs, measure is change in FEV1)?

Answer Options: • A. Cost-effectiveness • B. Cost-of-illness • C. Cost-minimization • D. Cost-utility • E. None of the above

Answer: A

Question: What type of pharmacoeconomic study is this (Uplift vs fluoxetine with quality of life and survival considered)?

Answer Options: • A. Cost-minimization • B. Cost-utility • C. Cost-of-illness • D. Cost-effectiveness • E. None of the above

Answer: B

Question: Which drug is considered cost-effective and is the best alternative (DrugX $5,000/20 yrs, DrugY $3,000/15 yrs)?

Answer Options: • A. DrugX dominates DrugY and therefore is the cost-effective alternative. • B. The cost-effectiveness ratio is ~$2,000 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: B

Question: Were the important or relevant clinical outcomes measured?

Answer Options: • A. Yes. LDL reduction is the main clinical outcome of interest in secondary MI. The duration was also appropriate. • B. Yes. The relevant outcomes were measured but the duration of the study (one year) was too long. • C. No. The condition of interest was prevention of secondary MI. LDL cholesterol is only a surrogate marker for the most relevant outcome, which is mortality. In addition, the study duration was not appropriate for the outcome—the study should have lasted much longer in order to follow patients until they have a second MI or die from it. In addition, this is a cost-minimization study so outcomes were not actually included. • D. No. The relevant outcomes were not measured—although hospital costs, drug costs and mean LDL reduction were appropriate, HDL cholesterol should also have been included. However, the duration was appropriate.

Answer: C

Question: Is this new vaccine program cost-effective? (5 additional life years, $495,000 more, λ = $60,000 per life-year)

Answer Options: • A. Yes. • B. No. • C. We cannot determine unless we have the value of lambda (λ). • D. It depends on their willingness to pay for vaccination. • E. None of the above.

Answer: B