Healthcare Economics ECONOMIC EVALUATION OF HEALTH PROGRAMS AND INTERVENTIONS Economic Evaluation Methods Identify, measure, value and

d compare the cost and outcome (consequence) Is there comparison of two or more alternatives? (Yes) Are both cost and consequence (outcome) of the alternatives examined? (Yes)

IMPORTANCE Of ECONOMIC EVALUATION 1. In case of scarce resource 2. In case of difference in objectives 3. In matter of life and death- it is important that we approach and decide for the the resources allocation in a clear and systematic way.

Economics concern with the assessment of every option available for the attainment of every objective. Each option have different costs and outcome Cost and Outcomes are measurable and have an effect on the future of those who made the decision. APPLICATION: Assessing Health Programs whether 1. Health resources are used optimally (right quantities, right mix) 2. Health programs are implemented efficiently 3. Health outputs are maximized Pharmacoeconomics Description and analysis of the cost of drug therapy to health care system and society Division of outcomes research that can be used to quantify the value of Pharmaceutical care "Weighing the cost of providing a product or service against the consequence (outcome)" Why? To determine which alternatives yields the optimal outcome per monetary value spent Assist clinicians to decide on what options would be the most Cost Effective Cost - Value of the resources consumed by a program or drug therapy of interest OUTCOME - Effects, output or consequences of the program or drug MEASURING COSTS 1. Medical care and administration (Provider Time and Inconvenience)

2. Follow up and Treatment 3. Time and pain of patient and family Measuring Costs and Outcomes Ideally, outputs or outcomes of health intervention (health effects) should outweigh the costs of such intervention To be able to assess this, we should be able to measure the costs involved in an intervention, and compare them with the effects of such. Therefore we have to learn the measurement of costs and their outcomes ***Quality Suffers; too much Emphasis on Costs Savings ***Quality and Costs Balance; Patients Receive Value

Overall cost of giving and receiving medical care OUTCOME: reduce morbidity and mortality, improve quality of life

COSTS are what society, government or individuals incur to run a program, or to produce something that they desire, like better health are different from the prices of goods are monetary value of producing a good or services, while prices are usually cost plus markup which is largely driven by market Needed by an individual to get something from programs Total Cost: Salary DIFFERENT KINDS OF COSTS 1. According to the Behavior of Costs A. Total Cost is the measure of all the costs needed in producing a given level output; aggregate or combined resource requirements (Ex Expenses incurred in running a vaccination program) B. Marginal Cost is the measure of the resources associated with a small incremental change in output. Ex. Adding extra vaccine C. Opportunity Cost is the cost of sacrificing other outputs/outcomes in favor of a chosen program due to limited resources (one program is given priority over another). Cost: How much earning potential has been sacrificed D. Average Cost is the measure of the total cost of production associated with each unit of output Total Cost/Quantity of Output 2. According to the relationship of costs to the product or service produced A. Direct Costs These are costs that can be directly attributed to a specific output or product. B. Indirect Costs These costs are incurred as sacrifice for being in an ill health, or in performing a healthproducing activity; like opportunity cost

Viewing Cost and Outcome in Different Perspectives Patients Perspective Ultimate consumer of health care service Cost - "What the patients pay for?" OUTCOME - "What is the effect to the patient?" Providers Perspective Cost is the actual expense of providing the product or service regardless of what the providers charge Hospitals, HMO, private physicians Outcome: Satisfaction of patients ( health care) Satisfaction of the patient Payers Perspective Insurance companies, employers, the government Charges for both health care products, services or reimbursed by the payer Outcome: Satisfaction of patients Societal Perspective The broadest of all perspectives Considers the benefit to society as a whole Patient Morbidity and Mortality

C. Intangible Costs These are costs attached to entities that we cannot touch and feel. 3. According to the frequency of incurring Costs A. Capital Costs These are costs for item with a life expectancy of more than a year .These costs are divided by their total usable life span. Ex building construction, purchase of equipment, basic manpower treatment Example: (Manufacturing) A building worth P10,000,000.00 was erected for a certain health program which will last for ten years. The monthly cost of the building will be computed as follows: P10,000,000.00/10 years/12 months per year = P83,333.33 per month B. Recurrent Costs These are costs necessarily incurred each year or each month Examples: salaries and wages of personnel; medical supplies, drugs, electricity, etc are all incurred, commonly, on a monthly basis TOTAL COSTS = Capital and Recurrent Costs Direct Medical Cost Cost incurred for medical products and services used to prevent, detect, and/or treat a disease Fundamental transactions associated with medical care that contribute in the portion of gross national product spent on health care Direct Non-medical Cost Any cost for non-medical services that are result of illness or disease but do not involve purchasing medical supplies or services Consumed to purchase service other than medical care Indirect Non-medical Cost Cost of reduced productivity (Morbidity and Mortality) Morbidity Cost - Cost incurred from missing work

Mortality Cost - Represents the years lost because of premature death Techniques to Estimate Indirect Nonmedical Cost Human Capital - Values morbidity and mortality losses based on an individuals earning capacity Willingness to Pay - "How much money are they willing to spend to reduce likelihood of illness" Intangible cost Other nonfinancial outcomes of disease and medical care Example: Pain, Suffering, Inconvenient Difficult to quantify and impossible to measure in terms of economic value Explicit Costs - Money paid by a firm to purchase the services of productive resources (outsource) Implicit Costs - The opportunity costs associated with a firms use of resources of it owns. These costs do not involve a direct money payment - wages, interest (your own machine) Total Costs - The costs, both explicit and implicit, of all the resources used by the firm Fixed Costs - Cost that does not vary with output. Average Fixed Costs - Fixed cost divided by the number of units produced. It always declines as output increases Variable Costs - Costs that vary with the rate of output. Ex. Wages paid to workers and payments for raw materials Average Variable Costs - The total variable cost divided by the number of units produced Average Total Costs - cost divided by the number of units produced. It is sometimes called per unit cost Marginal Costs - The change in total cost required to produce an additional unit output Incremental cost-Additional cost that a service or treatment alternative imposes over another compared with the additional benefit, effect or outcome. Extra cost required to purchase an additional unit of effect and provide another way to assess the pharmacoeconomic impact of a service or treatment option on a population (benefit should be greater)

Relationships among a Firms Costs 1. Total cost = explicit and implicit costs 2. Total costs = fixed cost + variable cost 3. Marginal cost = change in total cost per added unit of output 4. Average total cost = total cost / output 5. Average fixed cost = fixed cost/output 6. Average variable cost= variable cost/output 7. Average total cost = average fixed cost + average variable cost 3 Basic Elements determine the Total Cost of Therapy 1. Production costs - are the cost of producing the treatment Example: The production costs of treating hypertension include the costs of physician office visits to initiate and monitor therapy. the costs of any testing required to diagnose and monitor the disease. the cost of pharmaceutical products and services used to treat the disease. 2. Induced resource losses - are those costs incurred of treating and managing adverse effects of treatment Example: patients treated with antihypertensive medications frequently experience side effects such as dizziness, impotence and nasal congestion 3. Induced resource savings - are costs that are prevented as a result of successful treatment Example: untreated hypertension results strokes and heart attacks. Factors Affecting Health Cost 1. Growth in the aging population 2. Abundance of specialized providers 3. Surplus of hospital beds 4. Inadequate financing of services 5. Passive role of consumers 6. Increase in number of lawsuits Encouraging Cost Awareness 1. Some countries are trying doctors to be aware of more economical prescription to practices

2. Pharmacists are empowered to substitute cheaper equivalents unless the doctor has specifically forbidden substitution on the prescription 3. Consumer rights also play a role in economic in health services 4. The common practice of making specialist care accessible using referral from another doctor has the potential of reducing the cost of health care 5. Cost sharing can induce the consumer to require the provider to be cost conscious, but it does not work when patients have private insurance to cover their share of the costs. Cost sharing can have perverse effects Measuring Outcome Economical o Direct, indirect and intangible cost compared with the consequence of a treatment alternative Clinical o Medical events that occur as a result of disease or treatment Humanistic o Function or status or quality of life Outcomes are the effects of the health interventions for which the costs were incurred. Measuring Intermediate and Final Outcome Example: Achieving a decrease lipid level with the use of HMG CoA reductase inhibitor thus preventing myocardial infarction Positive OUTCOME Desired effect of a drug example: benefit, Life years gained, improved health condition Negative OUTCOME

Undesired or adverse effect of a drug, drug toxicity or even death

Outcome

Health Intervention

Outcome Measure

Costs of different alternative programs or intervention options Example: Ondasetron and granisetron are both used for the prevention of chemotherapy-induced nausea and vomiting If they are equally effective, then the choice between them could be made using a CMA. COST MINIMIZATION IN ANTIBIOTIC THERAPHY

Improvement of health

Renal Dialysis or Coronary Artery Bypass Graft Surgery

Life years gained as a result of the health intervention

Improvement of quality of life

Steroid + B2 Agonist Inhaler (Anti-Asthma Inhalers)

Better, more active life

Increased economic output

Influenza vaccination

Less work days lost because of better health

Monetary saving

Expanded program of Immunization

Less expenses for acute care and hospitalization because illness is prevented

Analysis: 1. Cost Minimization Analysis (CMA) Determination of the least costly alternatives when comparing two or more treatment alternatives Alternatives must have an assumed equivalency in safety and efficacy with the assumption that the outcomes of the interventions are measurably identical, the least cost option is chosen "Cost Savings" Finds the least expensive cost alternative Outcome - identical among alternatives Compares the costs of therapies that achieve the same outcomes

Cost of Dug A > Cost of Drug B 2. Cost Benefit Analysis (CBA) Identification, measurement, and comparison of the benefit and cost of programs or treatment alternatives Cost and benefit are measure and converted into equivalent monetary value Health benefits: numerator; cost: denominator Measures the yield of the alternative health interventions

Valuing Benefits what is the value of human life the values individuals place on things are based on the prices they are willing to pay for them Benefits are typically valued using the willingness-to-pay approach 4 Factors (individuals willingness to pay) 1. Wealth 2. Life expectancy 3. Current health status 4. The possibility of substitute Uses: 1. Comparing interventions with different outcomes Choice between investing in a prenatal nutrition program or an AIDS awareness program Useful when funds are limited and budget allocation decisions have to be made 2. Assessing single or multiple interventions or programs Effect of diet and exercise to control hypertension or diabetes Medication used in controlling hypertension and diabetes vs diet and exercise Expressed as ratio, net benefit or net cost

Example of a Cost-Benefit Analysis (prevent future cost) Assume that we are evaluating a project proposing to vaccinate 2,000 children for measles in a certain distant province. Assume also that the cost per child immunized is P300.00. We know that if we do not immunize these children for measles, there is good chance that they will contract it. Is it cost-beneficial for us to immunize all of them? ANALYSIS: Costs of immunizing 2,000 children at P300.00 each = P600,000.00 Cost of not immunizing children:

Benefit Cost
If B/C > 1, the program is of value (worthwhile) If B/C = 1,the program is equivalent to the cost If B/C < 1, the program cost overweighs the benefit

3. Cost Effectiveness Analysis (CEA) A way of summarizing the health benefit and resources used by competing health care programs.

 Cost is measured in monetary value, while effect is measured with specific therapeutic outcome or clinical measurement the most frequently used investigate the best way of achieving a single objective by comparing effects and costs when given a fixed budget, which intervention maximizes the effectiveness of the expenditures This ratio can be simplified by TOTAL COST/TOTAL HEALTH EFFECT

2. The treatment options may be different treatments for the same conditions Example: a. kidney dialysis compared with kidney transplantation b. Drug A and Drug B for the treatment of renal failure

MEASURING EFFECTIVENESS in CEA 1. Surrogate measures examine the clinical effect of a treatment option or its clinical efficacy but this is difficult to measure ---- Ex. Heart transplant 2. Intermediate measures include clinical effectiveness, or outcome Ex. Life years added due to Recovery EXAMPLE OF CEA 1. CEA relates the cost of 2 or more treatment options to a single, common consequences that differs among options Examples: immunization, blood pressure reduction, hip fracture, or increase life expectancy

3. Unrelated treatments with a common effect Example: life-saving treatment for heart disease compared to life saving treatment in end stage renal failure

4. New, more expensive and more effective agent is compared with an older, less expensive, and less effective product, which is the current standard of therapy Consider the ICER (incremental Costeffectiveness Ratio) to achieve the same type of health outcome: - to prolong life, reducing blood sugar, helping patients stop smoking, etc.

4. Cost Utilization Analysis (CUA) is another form of CEA but differs slightly because it measures the effect of a project program in terms of utilities Measures both effects on morbidity (quality of life) and mortality (quantity of life) in a single preference weighted index. Ratio is translated as cost per QualityAdjusted Life Year (QALY) QALY- means the quality of life gained assess perceived mental, physical and general functioning over time of the management of chronic diseases better understanding of how patients function from day to day with their illness Treatment of patients with chronic diseases focusing more on their quality of life than premature death or reduction of hospitalization days ( sense of well being, ability to perform daily activities, emotional state..) outcome is measured in terms of patient preference, willingness to pay or quality of the healthcare costs are expressed in terms of costs per QALY or QALYs per monetary unit measures the effects of a project program in terms of utilities (qualityadjusted health outcome caused or averted) minimizing cost/maximizing effect CEA, CMA, and CUA have costs as numerator and health effects as denominators therefore: Costs/Health Effects Compare drugs or programs that are: life extending but with serious side effect that produce reduction in morbidity MEASURING UTILIZATION 1. Surrogate measures examine the clinical effect of a treatment option or its clinical efficacy ( difficult to measure) ---- Ex. Heart transplant 2. Intermediate measures include clinical effectiveness, or outcome

Ex. Life years added due to Recovery 3. Final outcomes measures economic effectiveness - disease free days, life years saved, QALY (Quality Adjusted Life Year)

Example: QALYs Example 1: living for 3 months confined for tuberculosis treatment was worth only 1.8 months ( 3 months X 0.6) of regular time spent at home in good health Example 2: Living more 10 years confined in a hospital being treated for a contagious disease was considered to be worth only 6.5 years of normal life. (10 years x 0.65)

5. Cost- Consequence Analysis (CCA) Identical to cost-effectiveness analysis; except that there is more than one outcome measure and the costs and benefits are presented in disaggregated form. 6. Cost of Illness (COI) Cost-of-illness Evaluation attempt to represent the burden of the disease from a particular ailment or medical condition in monetary terms. Cost-of-illness studies are usually done to assess the cost to society of illness (e.g. stroke, cancer, and others). Cost-of-illness studies merely look at the costs associated with an illness and does not consider benefits. Hence, it does not belong to a category of a pure economic evaluation.

 Cost-of-illness studies are usually conducted by pharmaceutical companies in order to test their product marketing. Identifies and estimates the overall cost of a particular disease Used to provide baseline to compare prevention or treatment options Direct Cost + Indirect Cost

Costs attached to the available options are measured against the health effects or benefits that they will produce Economic evaluation should be done 3. Bang and Buck The comparison in an EE are made in term of cost and consequences (outcome). The specific cost to be included in the analysis are determined by 1. The individual patients (patient) 2. Health insurance company (payer) 3. Health plan of hospital/ physician (provider) 4. Government agency (payer) 5. Society as a whole (societal) Discussion: Economic evaluation Comparison of 2 or more alternative options Costs and consequences of the different alternative treatments Greater benefit at lower cost Balance between quality and cost Assessing the economic feasibility and efficiency of health interventions Partial Economic Evaluation Cost Analysis Study the cost w/o considering the consequences Efficacy and Efficiency Studies Focus on benefits/consequences/effects (treatment [w/o death]/health programs [not given worsen health condition] different objectives) not taking into consideration the cost Different Objectives Allocative efficiency Choose the optimum alternative w/ the use of limited resources w/c shall be maximized to help researches in the development of certain health problems Technical efficiency w/ minimal input, maximize the output Cost-effectiveness Maximize the benefit at lower costs

Sources of Data for Pecon Analysis stock/purchasing records adverse drug reaction data non-essential/non-formulary monitoring APPLICATIONS 1. Drug Development (clinical research and post marketing phase) 2. Drug Formulary Decisions 3. Evaluation of clinical treatment 4. Evaluation of pharmaceutical care services 5. Budget 6. Pricing

BASIC PRINCIPLES OF ECONOMIC EVALUATION 1. DECISION MAKING Economic evaluations are techniques done to evaluate options which all promise to produce better health 2. Comparing Costs with benefits

Input and processes have corresponding costs Benefit is converted to monetary unit to compare the benefit and cost intervention Health resources Assess programs Pharmacoeconomics Provide goods/services (responsible: pharmacist) w/ corresponding cost increase/decrease the cost corresponding to the effect of the intervention ***At whatever cost, the patient consider the benefit if they have enough resources Health related quality of life: free from sickness Book Maximizing the output: most important objective Economics How product activities undergo w/ different combinations of resource inputs HEALTH Resources: used optimally Programs: implemented efficiently Outputs: maximize Costs: produce better health; monetary value of producing a good/service Effects: ability to produce better health Price: driven by market forces

VIRTUE Is a habitual & firm disposition to do the good. It allows the person not only to perform good acts, but also to give the best of himself. God-given powers Holiness made easy. A good operative habit. The good use of our freedom The purpose of the LAW is to lead us to virtue. Develops through obedience to just laws.* ACQUIRED VIRTUES through the light of reason; as a good operative habit. INFUSED VIRTUES through the light of GRACE Theological Virtues The cardinal virtues & other virtues are rooted in the THEOLOGICAL VIRTUES which are the very foundations of Christian life. These are: FAITH, HOPE, & LOVE. FAITH Empowers us to believe in God & all that God has said & revealed. LOVE Charity or Love enables us to love God above everything for his own sake and to love our neighbor as God loves us. This is the virtue which perfectly binds together all other virtues. We cannot work for justice without love. To be just is to be loving and vice versa. PRUDENCE Is good common sense. Right reason in action St. Thomas A. Helps us to discover what is good in every situation & helps us to choose the right ways of achieving it. A prudent person always seeks the most loving & just thing to do in a given circumstance. The exercise of conscience is always guided by PRUDENCE. It is the capacity for DICERNMENT. It formulates & imposes the correct dictates of reason.

What is the best way for me, in this situation, to do the right thing? The prudent person must investigate the situation & take counsel from others. Prudence presupposes the ff. qualities: Knowledge of moral principles Ability to make rational inferences Vision or foresight Ability to weigh circumstances Ability to anticipate obstacles & plan to surmount them. Ability to decide. Fortitude Gives us the firmness, strength, & courage to deal with temptations, difficulties, & dangers in doing what is right and true. It is spiritual courage to do what is right, helping us conquer fear, even of death in defending a just cause. Temperance Moderates the attraction of pleasures & provides balance in the use of created goods. Is the virtue that enables us to control our appetites for these goods (food, drink, sexual pleasure) & use them in God-intended ways. We develop this virtue by acts of selfdenial. The Virtue of Justice It is the moral & cardinal virtue by which we give God & our neighbor what is their due by right. 4 TYPES OF JUSTICE: 1. Social Justice Applies the Gospel message of Jesus to the structures, systems, & laws of society in order to guarantee the rights of individuals. To contribute, participate in the social, political & economic institutions of society. 2. COMMUTATIVE JUSTICE is the justice of exchange. It calls for fairness in agreements & exchanges between individuals or private social groups. It requires respect of persons in our economic transactions, contracts or promises.

Commutative Justice requires that You get what you pay for. It also obliges that you pay what you get. Responsibly fulfill our obligations. 3. DISTRIBUTIVE JUSTICE Is justice that guarantees the common welfare. It involves sharing. It sees to the just distribution of the goods of creation that God intends for us all to use & share. The Universal Destination of Earthly Goods The right of having a share of earthly goods. PCP II: God destined the earth and all it contains for ALL peoples so that all created things would be shared by all under the guidance of justice & charity. Basic human dignity requires that each person has a right to enough of the earths goods to live a truly human life. The Right to Private Property Has an intrinsically social function. The persons social responsibility to share his access to the goods of the earth with those who lack the most basic necessity Paul VI indicated the limits the right to private property: Private property is not an absolute & unconditional right. No one is justified in keeping for his exclusive use what he does not need, when others lack necessities. (Pop.Prog., 23) As social beings & members of Gods family, we pay special attention to the weak & the poor. Preferential option & love for the poor. This is a fundamental Christian option, inspired by the teachings & examples of Jesus. Vs. a life of wanton extravagance while a great number of people exist in subhuman conditions. St. Basil : He who takes the clothes from a man is a thief. He who does not clothe the indigent, when he can, does he deserve another name but thief? The bread that you keep belongs to the hungry; to the naked the coat that you hide in your coffers; to the shoeless, the shoes that are dusty at your home; to the needy the silver that you

hide. In brief, you offend all those that can be helped by you. The Role of the Government The responsibility to make sure that everyones basic needs are met. A major reason we pay TAXES: to guarantee that all citizens will get an education, have police & fire protection, have access to health care & disability compensation in times of forced unemployment, and the like It is a matter of Proper allocation of budget & Ending of Corruption. 4. LEGAL JUSTICE Is the other side of distributive justice. Requires that citizens obey the laws of society. The moral virtues grow through: 1. Education --- Knowledge 2. Deliberate acts -- Action 3. Perseverance -- Practice DIVINE GRACE purifies & elevates them.

Blood Universal precaution: Treat all body fluids infectious CBC Hemoglobin Hematocrit RBC WBC Differential Count Hematocrit Volume of packed red cell after centrifugation PCV Adams micromethod Materials: capillary tube (red, blue) sealing clay/paraffin wax microhematocrit centrifuge machine microhematocrit reader Procedure: 1. Fill capillary tube with blood (3/4) 2. Seal. Label 3. Centrifugate. Use balancer 4. Spin 10,000 rpm 4-5min NR: male- 47 +/- 7 vol% / 0.47 +/- 7 female- 42 +/- 5 vol% * NB 56 +/- vol% Hemoglobin Heme Globin Pigment in the RBC Methods acid-hematin method Cyanmethemoglobin method Materials: N HCl Sahlis tube (w/comparator block) Sahlis pipette dH20 Stirring rod Procedure: 1. Deliver 0.01N HCl into Sahlis tube 2mark 2. Aspirate 0.02 mL blood 3. Expel blood into Sahlis tube 4. Rinse pipette with dH20-add into the tube 5. Add dH20 drop by drop comparator block 6. Read lower miniscus

NR:

male : 14-16.5 g/100mL or 14-16.5g% 140-165 g/L female: 12-15g/100mL

Hemacytometer

Used in counting RBC, WBC, Platelet, absolute eosinophil count, sperm count With thick cover slip Improved Neubauer Counting Chamber

1. 2.

3. 4. 5. 6.

WBC Count # of WBC in 1 cu mm of blood Dil fluid must lyze RBC Materials: WBC pipette Dil fluid hemacytometer Procedure: Aspirate 0.5 blood. Wipe sides Aspirate WBC dil fluid up to 11 mark. Mix diln 1:20 no bubbles, no over/under dilution Discard 2-3 gtt Charge counting chamber Stand 5min Count WBC in LPO

Cover glass thicker, less flexible, surface tension of the fluid will not deform them, height of the fluid is standardized Procedure 1. Prepare smear 2. Dry smear on flat surface 3. Stain smear 4. Count 100 cells in OIO Activity: 1. View slides 2. Fill out result form (add last column interpretation) Blood Groups Antigen agglutinogen Antibody agglutinin Reaction: agglutination

NR: RBC Count # of red cells in 1 cu mm blood Dil fluid lyze WBC Materials: RBC pipette Dil fluid hamacytometer Procedure: 1. Aspirate blood 0.5 mark. Wipe sides 2. Aspirate RBC dil fluid up to 101 mark. Mix diln 1:200 3. Discard 5-6 gtt 4. Charge counting chamber 5. Stand 5min 6. Count RBC in HPO Differential Count Granulocytes Agranulocytes Materials: Blood 2 slides Differential stain Pasteur pipette Cedar wood oil High refractive index, thereby increasing the numerical aperture of the objective lens Have specific optical and viscosity characteristics

Material: Lancet 70% alc 2 slides/member (3members) Typing sera (anti-A, anti-B, anti-D) ** sharps container yellow bag Procedure: 1. Label slides A, B, D 2. Sterilize finger 70% alc 3. Puncture finger 4. Wipe 1st drop of blood 5. Place 1gtt of blood on Slides A, B, D 6. Press punctured finger on cotton

7. Add 1gtt of anti A on slide A add 1gtt of anti B on slide B add 1gtt anti D on slide D 8. Mix blood and typing sera using applicator stick (1 per slide) 9. Gently tilt slide back and forth for 1min 10. Observe reaction (clumping) under fluorescent microscope 11. Record result Coagulation Time - Time it takes for the blood to clot - Clot - plugs the opening of the wounded blood vessel - Slide method: 3-6min Bleeding Time - Time it takes for a wound to stop bleeding - Duke Method: 1-3min Hemorrhage- when blood does not clot/does not stop bleeding Hemophilia- condition Application of CTBT Materials: 2 glass slides (2members) 70% alc Timer Lancet Filter paper Procedure for CT 1. Sterilize finger 2. Puncture-1 quick deep prick 3. Collect 2 big gtts on the slide. Start timing once bld in contact with slide 4. After 30 sec, draw the tip of the lancet thru the blood and observe for fibrin thread that clings on the lancet 5. Check every 30sec 6. Stop timer once you see a fibrin clinging on the lancet 7. Record result Procedure for BT 1. Sterilize finger 2. Puncture finger 3. Start timing once you see a blood come out 4. After 30 sec blot the gtt of bld with a filter paper 5. Do this after every 30 sec

6. Stop timing when theres no blot seen on filter paper 7. Record result

Blood Smearing 1. Place a small drop on one slide. 2. Pull the top slide back to contact with the drop which will spread by capillary action. 3. Push the top slide to produce a smear.

Blood Type: O+ (agg w/ anti-rh)

B+(agg w/ anti-B and Rh)

A+ ( agg w/ Anti-A and anti-Rh)

AB (agg w/ all)

Ag (Red Cells) A B AB O A B A,B None

Ab (Plasma)

Direct-Ag Anti-A Anti-B + + -

Reverse-Ab A cells + + B cells + +

Anti-B Anti-A None Anti-A & B

+ + -