Page 38 - FPGEE Management Q&A Book

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assessment of telephone inquiries on help lines. concluded relevant trials on the issue.
Help lines assist the plan member to resolve For example, one method frequently used is to
inquiries related to pharmacy benefits. Automatic normalize both costs and outcomes values for a
call distributor (ACD) measures the help line hypothetical population of 100 patients. If, for
performance for PBM. The following industry instance, the costs of the new treatment A is $7,000
standards are verified or measured: and the cost for treatment B is $3,000 for one year,
the cost for 100 patients is $700,000 and $300,000,
1. Calls received. respectively.
2. Calls answered.
3. Calls abandoned. Using the same methodology, if the new treatment
4. Abandoned rate. A reduces the recurrence rate from 39% to 15% of
5. Percent of calls answered within 30 seconds. the standard treatment B, this means that the new
6. Average speed of answer. treatment avoids a total of 24 recurrences for 100
7. Average talk time. patients. This constitutes the clinical benefit. It is
important to point out that both costs and
55.(b) The ECHO model measures the economic, outcomes need to refer to the same time frame; in
clinical and humanistic outcomes. This model was this example it is one year. Finally, to calculate the
developed by Kozma, Reeder and Schulz. Clinical Cost Effective Ratios (CER), the ratio between
outcomes are medical events that occur as a result incremental cost in the numerator ($400,000) and
of disease or treatment. incremental benefit in the denominator (24
recurrences) is calculated. The result is about
Economic outcomes are direct, indirect and $17,000 spent for each avoided recurrence.
intangible costs related to the consequences of
medical treatment alternatives, whereas humanistic The above procedure is a very simplified example of
outcomes are consequences of disease or short-term CEA over a one year time period. The
treatment on patient functional status or quality of major simplification is the time frame considered.
life. This model relies on the user to consider the The choice of one year makes the calculation easier,
more global clinical outcomes in the decision- but it excludes the contribution of significant events
making process. occurring later in the disease and treatment
process, related to both costs and outcomes.
56.(c) The unique generic name for a specific drug is Generally, these simplifications may be more or less
generally given by the USAN (United States Adopted acceptable, depending on the problem under study.
Name).
58. (a,b,c and d) A medication error is defined by
57.(d) In Cost Effective Analyses (CEA), the new the Institute for Safe Medical Practices (ISMP) as
treatment is compared with the standard treatment any error occurring in the medication-use process.
(usually, the best available treatment in clinical
practice, e.g. the gold standard) in terms of clinical The National Coordinating Council for Medication
and economic value. Error Reporting and Prevention (NCC MERP) defines
a medication error as the following:
If the treatment has just been launched on the
market, and a study cannot be carried out in the “Any preventable event that may cause or lead to
practice setting, effectiveness data is obtained from inappropriate medication use or patient harm while
published trials. In this situation, the most powerful the medication is in the control of the health care
trials (e.g. the one with the strongest methodology professional, patient, or consumer. Such events
as well as with the largest number of patients) may be related to professional practice, health care
should be considered. An alternative would be to products, procedures, and systems, including
use the results of meta-analysis comprising all the prescribing; order communication; product labeling,

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