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Institute of Health Management and Health Economics Faculty of Medicine University of Oslo English Institute of Health Management and Health Economics University of Oslo Written Exam, Friday 28 March 0900-1300 HMM4301-Optimal allocation of health care resources and economic evaluation of health care technologies (Economic Evaluation for short) Results will be posted on the board at the Institute of Health Management and Health Economics, Forskningsveien 3A. The results will also be posted on Studentweb. The receiving day of the results is the day the results are posted on the board outside the Institute. Appeals must be submitted within three weeks of this date. The Written Exam consists of 2 pages including this one. Remember to write down your candidate number so that you have it when the results are made available. Dictionary and Calculator can be used. 1 HEPATOSCLEROSIS (25%) In the country Faraway, the hypothetical liver disease hepatosclerosis shortens life expectancy by 10 years in young people who are infected. The disease can be cured with a drug (Sclerokill®) that is without side effects, but the drug is only effective in young individuals when the disease is asymptomatic. The drug is expensive, and can therefore not be used by everybody in Faraway. A test (Hepafind®), however, can be used to detect asymptomatic hepatosclerosis. The sensitivity of Hepafind® is 95% and the specificity is 80%. The prevalence of hepatosclerosis is 1%. The cost of Sclerokill® is $5000 per patient treated. Health authorities have two strategy choices: Do nothing Test and treat: Use the Hepafind® test and treat those with positive test with Sclerokill®. A. Develop a decision tree model and calculate the cost per life year gained by the test and treat strategy. In Faraway, the Ministry of Health and Finance has decided that discounting should not be undertaken in economic evaluation. B. In Faraway, the Ministry of Health and Finance has decided that the value of a life year is at maximum $12000. Should the health authorities adopt the test and treat strategy? C. How would discounting influence the result of the analysis and the policy implications (you need not do any calculations)? State all assumptions you use in your analysis 2 COSTING AND PERSPECTIVE (35%) Identification, quantification and valuation are three main components when we discuss costs in economic evaluation. Describe the different components. Discuss the difference between an economic evaluation from a health care sector perspective and from a societal perspective 3 BOOTSTRAPPING (15%) The bootstrap method can be used in sensitivity analysis i) According to Drummond et al., when is it relevant to use the bootstrap method? ii) Describe the method. 4 ETHICS (25%) Explain the health frontier, and which points on the frontier that correspond with: 1) egalitarianism: 2) utilitarianism (as health maximization), and; 3) a typical health related social welfare function involving trade-off between equality and health maximization.