CSP Pharmacoeconomics & Reimbursement 2 — Questions and Answers
Question 1: Specialty drug A costs $60,000 more than drug B and yields 1.5 additional QALYs. What is the ICER of A versus B?
- $40,000 per QALY (Correct answer)
- $90,000 per QALY
- $60,000 per QALY
- $24,000 per QALY
Correct answer: $40,000 per QALY
ICER = incremental cost / incremental effect = $60,000 / 1.5 QALYs = $40,000 per QALY.
Question 2: Two biosimilar products have demonstrated equivalent efficacy and safety. Which pharmacoeconomic analysis is most appropriate to choose between them?
- Cost-utility analysis
- Cost-benefit analysis
- Cost-minimization analysis (Correct answer)
- Cost-effectiveness analysis
Correct answer: Cost-minimization analysis
When outcomes are proven equivalent, only costs need comparison, so cost-minimization analysis applies.
Question 3: A health system values both the costs of a hepatitis C program and the avoided liver transplants in dollars. Which analysis is this?
- Cost-effectiveness analysis
- Cost-benefit analysis (Correct answer)
- Cost-utility analysis
- Cost-of-illness analysis
Correct answer: Cost-benefit analysis
Cost-benefit analysis expresses both inputs and outcomes in monetary units, allowing a net benefit or benefit-to-cost ratio.
Question 4: A new therapy is both less costly and more effective than the current standard. How is it described on the cost-effectiveness plane?
- Dominated
- Dominant (Correct answer)
- Extendedly dominated
- Cost-neutral
Correct answer: Dominant
An option that costs less and produces better outcomes dominates the comparator, so no ICER needs calculating.
Question 5: A 10-year model of a gene therapy reduces the present value of future costs and health outcomes, commonly at 3% per year. What is this practice called?
- Sensitivity analysis
- Inflation adjustment
- Half-cycle correction
- Discounting (Correct answer)
Correct answer: Discounting
Discounting reflects time preference by converting future costs and outcomes to present value, typically at about 3% annually in US analyses.
Question 6: A modeler draws all input parameters at once from probability distributions over 10,000 Monte Carlo iterations. Which technique is this?
- Probabilistic sensitivity analysis (Correct answer)
- One-way sensitivity analysis
- Threshold analysis
- Scenario analysis
Correct answer: Probabilistic sensitivity analysis
Probabilistic sensitivity analysis varies all uncertain parameters at once using distributions and often produces cost-effectiveness acceptability curves.
Question 7: What is the main purpose of a budget impact analysis that a health plan requests before adding a new specialty drug?
- Calculate cost per QALY gained over a lifetime
- Measure patient willingness to pay
- Estimate the financial effect of adoption on that plan's budget over a short time horizon (Correct answer)
- Compare the drug's clinical efficacy with placebo
Correct answer: Estimate the financial effect of adoption on that plan's budget over a short time horizon
Budget impact analysis estimates the affordability of adopting a therapy for a specific payer population, usually over 1 to 5 years.
