Costs utility

Krause, F., and Eto, J. 1988. Least-Cost Utility Planning, A Handbook for Public Utility Commissioners, The Demand Side Conceptual and Methodological Issues. Washington, DC National Association of Regulatory Utility Commissioners. 

Hornberger J, Holodniy M, Robertus K, Winnike M, Gibson E, Verhulst E (2007) A systematic review of cost-utility analyses in HIV/AIDS imphcations for public pohcy, Med Decis Making 27(6) 789-821... 

Three evaluative modes are discussed here cost-benefit analysis, cost-effectiveness analysis (and its recently distinguished variant cost-consequences analysis) and cost-utility analysis. Books by Drummond et al (1997) and Gold et al (1996)—the two most respected and widely cited texts on health economics evaluations—give excellent accounts of these modes of economic evaluation, and interested readers are referred to them for more advanced discussions. 

The most recently developed mode of economic evaluation is cost-utility analysis (CUA). It is similar to CFA with the important exception that it gauges the impact of an intervention, not in terms of a single... 

Cosr-utility analyses avoid the potential ambiguities that can arise with multidimensional outcomes. They can also be seen as an improvement on a single effectiveness measure in what is generally regarded as an inherently multidimensional world. The transparency of the methods used to derive utility is a particular strength of the approach. Cost-utility analyses are primarily justified—some would argue justified—... 

Cost-benefit analysis Cost-effectiveness analysis Cost-consequences analysis Cost-utility analysis Cost-offset analysis Comprehensive Comprehensive Comprehensive Comprehensive Comprehensive Monetary valuation of outcomes One outcome only Multiple outcomes measured Summary utility score of outcomes No outcomes measured... 

Outcome measurement is not discussed further in this chapter, hut it should he emphasized that some distinctive contributions could be made by economics. These include the development of summary unidimensional measures (discussed in the cost-utility section earlier), and benefit valuation in monetary terms (with its attendant difficulties, even though valuation methods are breaking new ground). However, acceptable (and potentially insightful) economic evaluations can be conducted without resorting to utility or benefit measurement. Cost-effectiveness and cost-consequences approaches have a lot to offer, building on outcome measures which will be more familiar to non-economist researchers in the field. It is for this reason that cost-effectiveness and cost-consequences analyses, linked to drug trials, are the most likely to be used over the next few years. 

With few exceptions, models find in favour of newer compounds Qonsson and Bebbington, 1994 Le Pen et al, 1994 McFarland, 1994 Stewart, 1994 Einarson et al, 1995 Lapierre et al, 1995 Nuitjen et al, 1995 Montgomeiy et al, 1996). One study (CCOHTA, 1997) did make allowances for variations in practice and patient behaviour. The results indicated that in the short term treatment was likely to be more successful with an SSRI than with a TCA, but at a higher cost. However, when treatment dropout rates found in naturalistic studies were substituted for drop-out rates found in controlled trials, the cost differences became smaller. When cost-utility analysis was applied, this increased cost was offset by improvements in quality of life for the patients. 

Cost-utility of maintenance treatment of recurrent depression with sertraline versus episodic treatment with dothiepin. Pharmacoeconomics 5,249—64. 

There are four types of economic evaluation cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The analytic framework chosen will depend upon the economic questions posed and the clinical evidence of effectiveness for the interventions (Gold et al, 1996 Dmmmondetal, 1997). 

Cost-utility analysis is similar to cost-efFectiveness analysis in approach, but uses utility as the outcome measure. The utility value is a measure that combines preferences for and values of the overall effect of an intervention on survival, physical and mental health, and social function. Utility is combined with estimates of length of life to provide an assessment of quality-adjusted life years (QALYs). As in cost-efFectiveness analysis, incremental cost-utility ratios are calculated to estimate the cost of producing one extra QALY. 

Utility operating cost Utility operating cost is usually the most significant variable operating cost after the cost of raw materials. This is especially the case for the production of commodity chemicals. Utility operating cost includes ... 

In order to associate a number to represent the utility of these four outcomes we have to choose between several types of economic evaluations, basically between cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The first of these is ruled out because it measures the health outcome in natural units. Given that the side effects of drags are of a varied nature, we need to be able to aggregate the different seriousness of these side effects in order to obtain a single utility, at least for the NSEA event. Furthermore, this utility must be comparable with that of, for example, the SER event. This is not possible with cost-effectivity. If we chose cost-utility, the utility associated with each event would be measured in QALYs gained or lost in each option. As QALYs are a universal measure of health benefit, cost-utility analysis could be appropriate for this type of decision. Lastly, cost-benefit analysis would also be appropriate, as it measures the utilities associated with each outcome in monetary terms, which reflect the willingness to pay for one of the outcomes in terms of safety and effectiveness. 

Cost-utility analysis Dollars Quality-adjusted life-years (QALYs)... 

Table 12.1 summarizes five major types of pharmacoeconomic evaluations cost-consequence, cost-benefit, cost-effectiveness, cost-minimization, and cost-utility (Drummond et al., 1997 Kielhorn and Graf von der Schulenburg, 2000). In a cost-consequence analysis, a comprehensive list of relevant costs and outcomes (consequences) of alternative therapeutic approaches are presented in tabular form. Costs and outcomes are typically organized according to their relationship to cost (direct and indirect), quality of life, patient preferences, and clinical outcomes (see taxonomy below). No attempt is made to combine the costs and outcomes into an economic ratio, and the interpretation of the analysis is left in large part to the reader. 

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. 

Ultimately, such assays may lead to studies to address the cost-utility and cost-efficacy of genotyping as a means to individualize guidelines for management of gastrointestinal and liver disease. 

Konski A, Scott C, Movsas B, et al. Cost-utility analysis of various treatments for non-small cell carcinoma of the lung (Abstract). Eur J Cancer 2000 36 S19. 

When several outcomes result from a medical intervention (e.g., the prevention of both death and disability), cost-effectiveness analysis may consider the outcomes together only if a common measure of outcome can be developed. Frequently, analysts combine different categories of clinical outcomes according to their desirability, assigning a weighted utility, or value, to the overall treatment outcome. A utility weight is a measure of the patient s preferences for his or her health state or for the outcome of an intervention. The comparison of costs and utilities sometimes is referred to as cost-utility analysis,... 

Decramer M, Rutten-van MoUcen M, Dekhuijzen PN, Troosters T, van Herwaarden C, Pellegrino R et al. Effects of N-acetylcysteine on outcomes in chronic obstructive pulmonary disease (Bronchitis randomized on NAC cost-utility smdy, BRONCUS) a randomised placebo-controUed trial. Lancet 2005 365(9470) 1552-60. Erratum Lancet 2005 366(9490) 984. Comment Lancet 2005 365(9470) 1518-20. 

Jones PB, Barnes TE, Davies L, Duim G, Lloyd H, Hayhurst KP, Murray RM, Markwick A, Lewis SW. Cost utility of the latest antipsychotic drugs in schizophrenia smdy (CUTLASS 1). Arch Gen Psychiatry 2006 63 1079-87. 

---