Cost Minimization Analysis (CMA) MCQs With Answer

Introduction: Cost Minimization Analysis (CMA) MCQs With Answer is a focused study tool designed for M.Pharm students preparing for exams in Pharmacoepidemiology & Pharmacoeconomics. This blog covers core concepts, assumptions, appropriate applications, and limitations of CMA — a method used when competing treatments produce equivalent clinical outcomes and only costs differ. Through targeted multiple-choice questions with clear answers, students will strengthen their ability to identify when CMA is appropriate, comprehend cost identification and measurement, and recognize methodological pitfalls such as hidden costs and equivalence verification. These MCQs deepen understanding and prepare students for practical and theoretical assessments in health economic evaluation.

Q1. Which of the following best describes Cost Minimization Analysis (CMA)?

• Analysis comparing costs when outcomes of alternatives are equivalent
• Analysis comparing cost per quality-adjusted life year (QALY)
• Analysis estimating willingness-to-pay thresholds
• Analysis comparing incremental cost-effectiveness ratios across interventions

Correct Answer: Analysis comparing costs when outcomes of alternatives are equivalent

Q2. What is the primary assumption that must be satisfied before performing a CMA?

• Interventions have been shown to be clinically equivalent in outcomes
• One intervention is clearly more effective than the other
• The interventions have identical cost structures
• No discounting is required for future costs

Correct Answer: Interventions have been shown to be clinically equivalent in outcomes

Q3. In which situation is CMA most appropriate?

• Two generic drugs with identical bioequivalence and clinical efficacy
• Comparing a vaccine with a new surgical technique
• Evaluating the cost per life-year gained of two different cancer therapies
• Estimating patient preferences for treatment attributes

Correct Answer: Two generic drugs with identical bioequivalence and clinical efficacy

Q4. Which costs are typically included in a CMA from the healthcare payer perspective?

• Direct medical costs such as drug acquisition, administration, monitoring, and hospitalization
• Indirect costs like productivity losses and caregiver time
• Intangible costs like pain and suffering measured in QALYs
• Societal costs including environmental impacts

Correct Answer: Direct medical costs such as drug acquisition, administration, monitoring, and hospitalization

Q5. If two interventions have different side-effect profiles but equivalent primary outcomes, is CMA appropriate?

• No — different side-effect burdens mean outcomes are not equivalent
• Yes — side effects are always excluded from CMA
• Yes — as long as drug acquisition costs are the same
• No — only safety outcomes matter, not side effects

Correct Answer: No — different side-effect burdens mean outcomes are not equivalent

Q6. Which methodological step is essential before conducting CMA?

• Establish equivalence of clinical effectiveness through trials or systematic review
• Perform sensitivity analysis on cost inputs only after CMA
• Calculate incremental cost-effectiveness ratio (ICER)
• Convert costs into QALYs

Correct Answer: Establish equivalence of clinical effectiveness through trials or systematic review

Q7. How should future costs be handled in CMA when comparing long-term interventions?

• Discount future costs to present value using an appropriate discount rate
• Ignore future costs because CMA compares only immediate costs
• Convert future costs into utilities
• Double future costs to account for inflation without discounting

Correct Answer: Discount future costs to present value using an appropriate discount rate

Q8. What is a common limitation of CMA?

• It cannot be used when there are meaningful outcome differences between interventions
• It always requires societal perspective costing
• It measures only intangible costs and ignores direct medical costs
• It provides incremental cost-effectiveness ratios for interventions

Correct Answer: It cannot be used when there are meaningful outcome differences between interventions

Q9. When performing CMA, which of the following should be verified about the equivalence claim?

• Robust evidence from head-to-head randomized controlled trials or well-conducted meta-analyses supporting equivalent clinical outcomes
• That both interventions cost exactly the same in all settings
• That both interventions are produced by the same manufacturer
• That patients prefer one intervention over another

Correct Answer: Robust evidence from head-to-head randomized controlled trials or well-conducted meta-analyses supporting equivalent clinical outcomes

Q10. For generic substitution decisions in a hospital formulary, CMA is often preferred because:

• Generics are bioequivalent, so clinical outcomes are expected to be equivalent and cost differences drive the choice
• Generics always have better safety profiles
• Generics require complex modeling of QALYs
• Generics cannot be evaluated by any other economic method

Correct Answer: Generics are bioequivalent, so clinical outcomes are expected to be equivalent and cost differences drive the choice

Q11. Which sensitivity analysis is most relevant in CMA?

• One-way sensitivity analysis on key cost drivers and scenario analyses for practice variation
• Probabilistic sensitivity analysis on QALY estimates
• Threshold analysis to find the ICER cutoff
• Network meta-analysis of clinical effectiveness

Correct Answer: One-way sensitivity analysis on key cost drivers and scenario analyses for practice variation

Q12. When reporting CMA results, which metric is most commonly presented?

• Total and incremental costs per patient for each alternative
• Cost per life-year gained
• Cost per QALY gained
• Net monetary benefit with willingness-to-pay threshold

Correct Answer: Total and incremental costs per patient for each alternative

Q13. If two treatments are clinically equivalent but one requires more monitoring visits, how should CMA account for this?

• Include the additional monitoring visit costs in the cost comparison
• Ignore monitoring costs because clinical outcomes are equivalent
• Adjust clinical equivalence to favor the cheaper monitoring schedule
• Convert monitoring visits into utility decrements

Correct Answer: Include the additional monitoring visit costs in the cost comparison

Q14. Which perspective excludes indirect costs such as productivity losses in CMA?

• Healthcare payer perspective
• Societal perspective
• Patient perspective
• Employer perspective

Correct Answer: Healthcare payer perspective

Q15. If an intervention has lower drug acquisition cost but leads to more non-drug resource use (e.g., hospitalizations), CMA will:

• Require full accounting of all relevant downstream resource use to determine net cost differences
• Automatically favor the lower acquisition cost and ignore downstream events
• Be invalid because downstream events are irrelevant
• Convert downstream events into QALYs for the analysis

Correct Answer: Require full accounting of all relevant downstream resource use to determine net cost differences

Q16. Which of the following is NOT an appropriate substitute for CMA when outcomes differ?

• Cost-Effectiveness Analysis (CEA)
• Cost-Utility Analysis (CUA)
• Cost-Benefit Analysis (CBA)
• Cost-Minimization Analysis (CMA)

Correct Answer: Cost-Minimization Analysis (CMA)

Q17. Which data source is most suitable to estimate unit costs in a CMA?

• Hospital accounting systems, price lists, and published tariffs for healthcare services
• Patient satisfaction surveys
• Clinical trial efficacy endpoints only
• Qualitative focus group reports

Correct Answer: Hospital accounting systems, price lists, and published tariffs for healthcare services

Q18. In a CMA comparing two antibiotics with equal cure rates, which cost elements should be considered?

• Drug acquisition, administration time, monitoring tests, adverse event management, and length of stay
• Only the wholesale price of the antibiotic
• Only the marketing costs associated with each antibiotic
• Only patient out-of-pocket copayments without considering clinical resource use

Correct Answer: Drug acquisition, administration time, monitoring tests, adverse event management, and length of stay

Q19. Why might CMA results vary between countries for the same intervention pair?

• Differences in unit costs, practice patterns, healthcare delivery, and reimbursement policies
• Clinical equivalence depends solely on language differences
• Because CMA uses a universal global price list
• Because CMA does not include costs, only clinical outcomes

Correct Answer: Differences in unit costs, practice patterns, healthcare delivery, and reimbursement policies

Q20. What is the recommended reporting practice for CMA according to economic evaluation guidelines?

• Clearly justify the use of CMA by presenting evidence of outcome equivalence and transparently report all cost components, perspective, time horizon, discount rate, and sensitivity analyses
• Report only the cheapest option without methodological justification
• Omit sensitivity analyses because CMA assumes certainty in costs
• Present results only as incremental cost-effectiveness ratios

Correct Answer: Clearly justify the use of CMA by presenting evidence of outcome equivalence and transparently report all cost components, perspective, time horizon, discount rate, and sensitivity analyses

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