Cost-effectiveness analysis , health care

Nowadays a drug company has not only to show its paymasters - governments, insurers and so on - that its new prodnct is safe and works, but also that it is cost-effective. In Anstralia, this has been spelled out in legislation. Since 1993, any drng submitted for approval must be accompanied not only by the resnlts of clinical trials bnt also by an economic impact analysis. In 1999, the United Kingdom set np a National Institnte for Clinical Excellence (NICE) to advise the National Health Service on the cost-effectiveness of health care technologies. Other countries ask formally or informally for pharmacoeconomic analysis. Economic impacts can be measured in a variety of ways, for example, cost-effectiveness, cost-utility or full cost-benefit stndies. 

In a cost-benefit analysis, both costs and consequences are valued in dollars and the ratio of cost to benefit (or more commonly benefit to cost) is computed. Cost-benefit analysis has been used for many years to assess the value of investing in a number of different opportunities, including investments (or expenditure) for health care services. Cost-effectiveness analysis attempts to overcome (or avoid) the difficulties in cost-benefit analysis of valuing health outcomes in dollars by using nonmonetary outcomes such as life-years saved or percentage change in biomarkers like serum cholesterol levels. Cost-minimization analysis is a special case of cost-effectiveness analysis in which the outcomes are considered to be identical or clinically equivalent. In this case, the analysis defaults to selecting the lowest-cost treatment alternative. Cost-utility analysis is another special case of cost-effectiveness analysis in which the value of the outcome is adjusted for differences in patients preferences (utilities) for the outcomes. Cost-utility analyses are most appropriate when quality of life is a very important consideration in the therapeutic decision. 

Economic evaluation compares costs and consequences of alternative health care treatments or programs (Drummond et al. 2005). In one form of economic evaluation, cost-benefit analysis, all costs and consequences are valued in monetary terms. However, in health care it is much more common to use cost-effectiveness analysis, where the difference in cost between alternatives is compared with the difference in outcomes measured in units such as life years gained or quality-adjusted life years (QALYs) gained. 

Donaldson C., G. Currie, and C. Mitton. 2002. Cost-Effectiveness Analysis in Health Care Contraindications. British Medical Journal 325 891-894. 

As with the translation of clinical outcomes into monetary measures, there also are difficulties associated with combining different outcomes into a common measure in cost-effectiveness analysis. However, it generally is considered more difficult to translate all health benefits into monetary units for the purposes of cost-benefit analysis than to combine clinical outcome measures. Thus, cost-effectiveness analysis is used more frequently than cost-benefit analysis in the medical care literature. 

Warner KE, Luce BR. Cost benefit and cost effectiveness analysis in health care principles, practice and potential. Ann Arbor (MI) Health Administration Press 1982. 

Etemad LR, Hay JW. 2003. Cost-effectiveness analysis of pharmaceutical care in a medicare dmg benefit program. Value Health 6 425. 

Cost-effectiveness and cost-benefit analyses are frequently mentioned in academic and policy-analysis circles. These notions center on careful examination of the costs and their corresponding outputs. Eisenberg defines cost-effectiveness analysis as the measure of the net cost of providing service (expenditures minus savings) as well as the results obtained (e.g., clinical results measured singly or a series of results measured on some scale). Cost-benefit analysis determines whether the cost is worth the benefits by measuring both in the same units. Such analyses will be critical, as future policy decisions are made with regard to the collection, allocation, and utilization of finite resources in the health care system for the enhancement of health status of the American people. 

The use of MEMS technology in the health care arena leads to the developments of indispensable sophisticated intelligent devices. The miniaturization of these analytical devices is critical since it wiU enable the analysis of large number of drugs per sample and may be used directly with small biopsy s samples or small volumes of body fluids. This in turn leads to fast response time, sensitive and cost-effective analysis. 

O Brien B, Drummond MF, Labelle RJ, Willan A (1994). In search of power and significance issues in the design and analysis of stochastic cost-effectiveness studies in health care. Med Care 32, 150-63. 

Shah and Jenkins (2000) in a review of mental health economic studies from around the world identified 40 cost-of-illness studies, of which five covered all disorders, one neuroses, two panic disorders and one anxiety. All were from developed countries. There were numerous cost-effectiveness studies but none involving the anxiety disorders specifically. One study in the UK examined the cost-benefit analysis of a controlled trial of nurse therapy for neurosis in primary care (Ginsberg et al, 1984). 

Chemical vapor sensors play an ever-increasing role in the environmental monitoring, homeland security, defense, and health care. The desirable characteristics of a chemical vapor sensor include ultrahigh sensitivity, specific and rapid response to certain vapor molecules, as well as the ability for on-the-spot chemical analysis, which usually requires the sensor to be small, portable, reusable, stable, robust, and cost effective. Toward this end, various sensing techniques have been studied... 

Clinical pharmacology plays no less significant a role in primary health care. That includes emphasis on essential drugs, safe and rational use of essential medicines including their side effects and outcomes, drug data transmission and analysis, and training with emphasis on prevalent diseases. Interactions between orthodox and traditional (complementary) medicines are carefully considered. Cost-benefit analysis is made possible. 

Health economics is concerned with the cost and consequences of decisions made about the care of patients. It therefore involves the identification, measurement, and valuation of both the costs and the consequences. The process is complex and is an inexact science, The approaches to economic evaluation include (1) cost minimization, (2) cost benefit, (3) cost effectiveness, and (4) cost utility analysis (Table 13-2). 

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