Health care economics analysis evaluation

Economic studies should consider the costs of all the resources and services used in the process of care. In addition, the outcomes that are a consequence of the health or social care interventions evaluated need to be included. For dementia, these include the costs of hospital inpatient and out-patient care, primary and community-based health-care services, social welfare services, and care provided by voluntary agencies or by femily and friends. Ideally, a broad perspective reflecting the costs and outcomes to society should be adopted. As a minimum, the perspective of the analysis should include the costs and outcomes to key health and social care providers or funders and to patients and their families. 

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. 

About the Author Dr. Mosavin is Chair of the Department of Pharmaceutical Sciences and Associate Professor in the Department of Pharmacotherapy and Outcomes Science at Loma Linda University s School of Pharmacy. Dr. Mosavin received a B.S. in Pharmacy from the University of Kansas, a Ph.D. in Pharmaceutical Sciences from the University of Wisconsin—Madison, and an MBA from the University of Chicago. Dr. Mosavin has experience in pharmaceutical industry, hospital pharmacy, and ambulatory care pharmacy settings. His research interests encompass economic evaluation of health care delivery systems and the role of pharmacists in these systems (especially as it relates to management of chronic diseases by pharmacists). Another key area of his research is analysis of economic gains achieved by health information technology implementation in ambulatory care pharmacy practice. 

As when evaluating the published medical literature, results from economic analyses should not be taken at face value . Reports should be detailed, clear and transparent. It is crucial that readers be able to follow exactly what was done (with justification) throughout the analysis. Care should also be taken to determine that the type of analysis performed (for example CEA, CBA) corresponds with the analytical technique purported to be used in the study. Zarnke and colleagues sampled the published literature to assess whether evaluations labelled as cost-benefit analyses met the contemporary definition using CBA methodology. They reported that 53% of the 95 studies assessed were reclassified as cost comparisons because health outcomes were not appraised. Several authors have developed checklists that are useful when evaluating the overall quality of an economic analysis. One of the best-known checklists is given in Box 20.1. 

H.-M. Spath, M.-O. Carrere, B. Eervers and T. Philip, Analysis of the eligibility of published economic evaluations for transfer to a given health care system - Methodological approach and application to the French health care system. Health Policy 4,9(5) (1999), 161-177. 

Economic Analysis is vital to justify the implementation of new diagnostic tests into resource limited health-care systems. POCTs are often more expensive on a test-by-test basis due to the scaling and portability of devices and not benefiting from the efficiency of large-scale multiplex laboratory testing of multiple samples. However, POCT can have benefits further down the clinical pathway such as those described in Table 2.1. These indirect cost savings can only be established by performing a comparative evaluation of the clinical pathway with and without the test. 

To be useful to those concerned with choices in the allocation of health and social care resources, the data for economic evaluations need to be timely, relevant, credible and accurate (Davies, 1998). As a minimum, the costs associated with the interventions should be estimated from activity data, which quantify resources used, and price or unit cost data. Often evidence from well-controlled prospective trials with high internal validity is required to establish whether differences in economic end points are directly attributable to the interventions. However, the economic evaluations of acetylcholinesterase inhibitors estimated costs from retrospective analysis of available datasets Qonsson et al, 1999b), analysis of published literature (e.g. Stewart et al, 1998) and expert opinion (e.g. O Brien et al, 1999 Neumann et al, 1999). This means that it is not clear whether differences in costs were due to the anticholinesterase inhibitors or to other factors such as availability of services in different areas, the living situation of the patient, or disease severity. 

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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