Cost of Illness (COI) and Cost Consequence Analysis (CCA) MCQs With Answer

Introduction: This quiz set focuses on Cost of Illness (COI) and Cost-Consequence Analysis (CCA), two foundational methods in pharmacoeconomics used to quantify the economic burden of diseases and to present costs alongside multiple outcomes. Designed for M.Pharm students, the questions explore study design choices (prevalence vs incidence), cost categories (direct, indirect, intangible), valuation methods (human capital vs friction cost), data sources, and practical interpretation of CCA outputs. Emphasis is placed on methodological strengths, limitations, perspective selection, and appropriate applications in healthcare decision-making. These MCQs will deepen conceptual understanding and prepare students for applied pharmacoeconomic analyses and critical appraisal of published studies.

Q1. Which statement best defines a prevalence-based cost-of-illness (COI) study?

• A study that measures lifetime costs for new cases occurring in a given time period
• A study that estimates costs for all existing cases during a specified time period
• A study that compares costs between exposed and unexposed populations
• A study that assesses only direct medical costs over a patient’s lifetime

Correct Answer: A study that estimates costs for all existing cases during a specified time period

Q2. Which of the following is a key advantage of a bottom-up (micro-costing) approach in COI studies?

• It requires less data collection effort than top-down costing
• It provides detailed patient-level cost estimates and captures heterogeneity
• It is the preferred method when only aggregate expenditure data are available
• It automatically includes intangible costs without separate measurement

Correct Answer: It provides detailed patient-level cost estimates and captures heterogeneity

Q3. In COI studies, which cost category typically includes lost productivity due to premature mortality and morbidity?

• Direct medical costs
• Direct non-medical costs
• Indirect costs
• Intangible costs

Correct Answer: Indirect costs

Q4. Which method for valuing lost productivity assumes that lost work time equals lost economic output until retirement?

• Friction cost method
• Human capital method
• Willingness-to-pay method
• Quality-adjusted life-year approach

Correct Answer: Human capital method

Q5. Which perspective in COI and pharmacoeconomic analyses typically includes both healthcare costs and productivity losses?

• Health care provider perspective
• Payer perspective
• Societal perspective
• Patient perspective

Correct Answer: Societal perspective

Q6. What is a defining feature of Cost-Consequence Analysis (CCA) compared with Cost-Effectiveness Analysis (CEA)?

• CCA aggregates all benefits into a single outcome measure like QALYs
• CCA presents a disaggregated list of multiple outcomes alongside costs without summary ratios
• CCA always requires discounting while CEA does not
• CCA only includes direct medical costs and excludes indirect costs

Correct Answer: CCA presents a disaggregated list of multiple outcomes alongside costs without summary ratios

Q7. Which limitation is most commonly associated with prevalence-based COI studies?

• They underestimate the short-term economic burden of a disease
• They cannot capture costs for chronic diseases
• They do not reflect lifetime costs or costs associated with incident cases
• They always require primary data collection only

Correct Answer: They do not reflect lifetime costs or costs associated with incident cases

Q8. When performing a CCA to inform formulary decisions, what is the main benefit of presenting multiple outcome measures separately?

• It forces a single decision metric for all stakeholders
• It allows decision makers to weigh costs against each outcome according to local priorities
• It simplifies economic evaluation by ignoring clinical outcomes
• It eliminates the need for sensitivity analysis

Correct Answer: It allows decision makers to weigh costs against each outcome according to local priorities

Q9. Which data source is most appropriate for a top-down COI analysis of national health service expenditures?

• Patient-level chart review from a single hospital
• National health accounts and aggregated reimbursement data
• Time-and-motion studies of individual clinicians
• Patient self-reported diary data only

Correct Answer: National health accounts and aggregated reimbursement data

Q10. In the friction cost method for productivity losses, the “friction period” refers to:

• The time until a worker becomes permanently disabled
• The period until the economic loss is fully realized at a national level
• The time taken to replace a lost worker and restore production
• The interval used to discount future productivity losses

Correct Answer: The time taken to replace a lost worker and restore production

Q11. Which of the following best describes intangible costs in COI studies?

• Costs for medications and hospital stays
• Non-medical transport and caregiver expenses
• Monetary valuation of pain, suffering, and reduced quality of life
• Costs reimbursed by third-party payers only

Correct Answer: Monetary valuation of pain, suffering, and reduced quality of life

Q12. Why is discounting applied in COI studies that project costs over many years?

• To adjust for inflation only
• To reflect that future costs and benefits are valued less than present ones
• To convert non-monetary outcomes into monetary units
• To eliminate the need for sensitivity analyses

Correct Answer: To reflect that future costs and benefits are valued less than present ones

Q13. Which scenario is a typical appropriate use of CCA rather than a cost-utility analysis?

• When a single outcome (e.g., QALYs) fully captures decision objectives
• When interventions affect multiple heterogeneous outcomes that stakeholders value differently
• When the decision requires a single cost-per-outcome threshold-based decision
• When measuring health utility weights is straightforward and uncontroversial

Correct Answer: When interventions affect multiple heterogeneous outcomes that stakeholders value differently

Q14. Which sensitivity analysis approach is most suitable to explore uncertainty in key COI input parameters such as unit costs and frequencies?

• One-way deterministic sensitivity analysis
• Reporting only point estimates without ranges
• Excluding non-significant cost items
• Using fixed average values for all parameters

Correct Answer: One-way deterministic sensitivity analysis

Q15. In a COI study from the healthcare payer perspective, which cost element is most likely excluded?

• Reimbursement for hospital procedures
• Out-of-pocket patient transportation expenses
• Pharmaceutical reimbursement by the insurer
• Costs of physician visits covered by the payer

Correct Answer: Out-of-pocket patient transportation expenses

Q16. Which of the following describes a major criticism of COI studies when used to prioritize health interventions?

• COI studies provide the incremental cost-effectiveness of interventions
• COI quantifies burden but does not inform the cost-effectiveness of prevention or treatment options
• COI always overestimates indirect costs relative to direct costs
• COI studies are universally generalizable across all countries

Correct Answer: COI quantifies burden but does not inform the cost-effectiveness of prevention or treatment options

Q17. When presenting a CCA table for a new cancer drug, which elements should be included to meet best practice?

• A single aggregated cost-per-QALY value only
• Separate rows for costs (by category) and multiple clinical outcomes without aggregation
• Only clinical outcomes without any cost information
• Only indirect costs because they are most relevant

Correct Answer: Separate rows for costs (by category) and multiple clinical outcomes without aggregation

Q18. Which approach improves external validity when COI estimates are transferred between countries?

• Using local unit costs and adjusting resource use to the target setting
• Applying unit costs and resource use directly from the source country without change
• Converting currency using nominal exchange rates only
• Excluding indirect costs to simplify transferability

Correct Answer: Using local unit costs and adjusting resource use to the target setting

Q19. Which statement is true regarding the reporting of methods in COI and CCA studies?

• Detailed reporting of data sources, costing methods, perspective, and time horizon is unnecessary
• Transparent documentation of assumptions, perspective, and costing approach is essential for interpretation
• Methodological choices can be omitted if results are statistically significant
• Only final cost totals should be reported to avoid confusing readers

Correct Answer: Transparent documentation of assumptions, perspective, and costing approach is essential for interpretation

Q20. Which outcome would most likely NOT be included in a CCA for an antihypertensive program aimed at reducing cardiovascular events?

• Number of stroke events averted
• Change in systolic blood pressure (mmHg)
• Total program implementation cost
• Household willingness to pay for unrelated consumer goods

Correct Answer: Household willingness to pay for unrelated consumer goods

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