Economic Evaluations
When the decisions to be made will affect large groups or population, rather than individuals, it is best not to base such decisions only on the efficacy or effectiveness of one strategy over another. In addition to weighing up treatments’ benefits and risks, these population-based decisions call for a deeper analysis to make sure that the actual benefits justify the amount ofresources used.
In Latin American and Caribbean countries, where health resources are limited, investing wisely is crucial. It is necessary to find the best way to “buy more health” with the available budget.
In this context, economic evaluations of clinical practices are an important tool. These evaluations include a group of formal and quantitative methods to compare strategies related to health results, resources, and costs.
When two strategies are analyzed only on monetary terms, the information obtained is insufficient, limited only to the use of resources (what is known as cost analysis). On the other hand, studies that compare the efficacy of two strategies (such as a clinical trial) only provide information about the results. A complete economic evaluation comparatively analyzes both the costs and theconsequences of each strategy, program or treatment. The IECS conducts this type of assessment and prepares HTA documents. Summaries of these documents are available in Spanish, English, and Portuguese.
Types of Studies
Complete economic evaluations have a different way of measuring benefits.
Cost-minimization analysis: this method is used to compare programs with equivalent consequences.
Cost-effectiveness analysis: this method is used to assess natural units (e.g. life-years gained, cases of renal failure avoided, etc.).
Cost-utility analysis: this method is used to assess quality-adjusted life-years (QALYs or AVAC, for its Spanish acronym) (a combination of the duration of life and the health-related quality of life).
Cost-benefit analysis: in this method a monetary value is placed on health benefits.
The elements of an economic evaluation:
Summary of elements included in economic evaluations:
Overall study design: e.g. decision trees, Markov models, and epidemiological models.
Analysis perspective: prepaid health plans and social security.
Compared alternatives: comparison of relevant alternatives (e.g. current dialysis versus dialysis + disease management).
Measurement of benefits: incidence of pathologies, mortality rates, life expectancy (QALYs, in the case of cost-utility analyses).
Source(s) of effectiveness data: extensive literature search of clinical trials and systematic reviews or meta-analyses.
Source(s) of Quality-of-life data: only in cost-utility analyses (QALYs).
Estimation of used resources: epidemiological data, local data-based models (based on Argentine data).
Source(s) of costs data: local costs, different situation within Argentina.
Discount rate: this is only considered for long-term models (3% annually).
Sensitivity analysis: this entails assessing the importance of each variable in the final outcome of the analysis (effectiveness of disease management, costs, use of resources, etc).
For more information about the elements of an economic evaluation, check the list of CHEERS (Consolidated Health Economic Evaluation Reporting Standards) (http://www.bmj.com/content/346/bmj.f1049)
