Abstract
Health care procedures are not generally provided and consumed as an end in themselves, but as a means of improving the expected health status of those undergoing the procedures. Health technology assessment aims to provide objective information about the impacts of technologies, including safety, effectiveness, outcomes and costs, as well as social and ethical consequences, in order to assist in making health care decisions and setting health policy. Aging populations, changes in the incidence of diseases and the increasing expectations of populations associated with the rapid developments in medical research have all led to increased pressures on health care systems. In response to these pressures an increasing amount of literature has focussed on the economic evaluation of health care programmes over the lastly twenty five years or so. Studies that have appraised the methods adopted in these evaluations have reported a low1,2 and reducing3,4 rate of compliance with the recommended (and published guidelines for economic evaluations5–11 and have led others to comment on the use and misuse of the evaluation terminology.12
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References
Drummond MF. (1980b) Studies in economic appraisal in health care. Oxford University Press, Oxford.
Drummond MF, Ludbrook A, Lowson K, Steele A. (1986) Studies in economic appraisal in health care. Volume 2, Oxford University Press, Oxford.
Warner KE, Hutton RC. (1980) Cost-benefit and cost-effectiveness analysis in health care: Growth and composition of the literature. Medical Care, 18:1069–1084.
Udvarhelyi S, Colditz GA, Rai A, Epstein AM. (1992) Cost-effectiveness and cost-benefit analyses in the medical literature: are the methods being used correctly? Annals of Internal Medicine, 116:238–244.
Weinstein MC, Stason WB. (1977) Foundation of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 296:716–721.
Shepard DS, Thompson MS. (1979) First principles of cost-effectiveness analysis in health. Public Health Reports, 94:535–543.
Sugden R, Williams A. (1978) The principles of practical cost-benefit. Oxford University Press, Oxford.
Drummond MF. (1980) Principles of economic appraisal in health care. Oxford University Press, Oxford.
Warner KE, Luce BR. (1982) Cost-benefit and cost-effectiveness analysis in health care. Health Administration Press, Ann Arbor, Michigan.
Drummond MF, Stoddart GL, Torrance GW. (1987) Methods for the economic evaluation of health care programs. Oxford University Press, Oxford.
Eisenberg JM. (1989) Clinical Economics: A guide to the economic analysis of clinical practices. Journal of American Medical Association, 262:2879–2886.
Doubilet P, Weinstein MC, McNeil BJ. (1986) Use and misuse of the term “cost-effective” in medicine. New England Journal of Medicine, 314:253–256.
Williams A. (1983) The economic role of “health indicators” in G. Teeling Smith (ed.) Measuring the Social Benefits of Medicine. Office of Health Economics, London, 63–67.
Mooney G. (1986) Economics, medicine and health care. Wheatsheaf, Brighton.
Wagstaff A. QALYs and the equity-efficiency trade-off. Journal of Health Economics. 1991;10:21–41.
Green A, Barker C. (1988) Priority setting and economic appraisal: Whose priorities — the community or the economist? Social Science and Medicine, 26:919–929.
Donaldson C. (1990) The state of the art of costing health care for economic evaluation. Community Health Studies, 9:341–356.
Torrance GW. (1986) Measurement of health state utilities for economic appraisal. Journal of Health Economics, 5:1–30.
Feeny D, Torrance GW. (1989) Utility and quality-adjusted life years. International Journal of Technology Assessment in Health Care, 5:559–575.
Donaldson C, Mooney G. (1991) Needs assessment, priority setting, and contracts for health care: an economic view. British Medical Journal, 303:1529–1530.
Donaldson C. (1992) Agenda for health: an economic view. British Medical Journal, 304:770–771.
Laupacis A, Feeny D, Detsky A, Tugwell P. (1992) How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Canadian Medical Association Journal, 146:473–481.
Drummond M. (1987) Resource allocation decisions in health care: A role for quality of life assessments? Journal of Chronic Diseases, 40:605–616.
Culyer A. (1981) Health, economics and health economics in J. VanderGeoz and M. Perlman (eds.) Health, Economics and Health Economics, North Holland, Amsterdam, 3–11.
Birch S, Donaldson C. (1987) Applications of cost-benefit analysis to health care: Departures from welfare economic theory. Journal of Health Economics, 6:211–225.
Gafni A. (1989) The quality of QALYs (quality-adjusted life-years): Do QALYs measure what they at least intend to measure? Health Policy, 13:81–83.
Gafni A, Birch S. (1993) Searching for a common currency: critical appraisal of the scientific basis underlying European harmonization of the measurement of health related quality of life (EuroQol). Health Policy, 1993; 23: 219–228.
Johannesson M, Pliskin J, Weinstein M. Are healthy years equivalent an improvement over Quality-adjusted Life Years? Medical Decision Making. 1993; 13: 281–286.
Culyer A, Wagstaff A. QALYs versus HYEs. Journal of Health Economics. 1993; 12: 311–323.
Mehrez A, Gafni A. Healthy-years Equivalents versus Quality-adjusted Life Years: In pursuit of progress. Medical Decision Making. 1993; 13: 287–292.
Gafni A, Birch S, Mehrez A. Economics, health and health economics: HYEs versus QALYs. Journal of Health Economics. 1993; 12:325–339.
Gafni A, Zylak CJ. Ionic versus nonionic contrast media: a burden or bargain? Canadian Medical Association Journal. 1990; 143: 475–478.
Gafni A. Considerations of the measures useful for quantifying adverse effects of unnecessary hypertension drug therapy. Clinical and Investigative Medicine, 1991; 14:266–270.
Read JL, Quinn RJ, Berwick DM, Finberg HV, Weinstein MC. Preference for health outcomes: comparison of assessment methods. Medical Decision Making. 1984; 4: 315–329.
Hornberger JC, Redelmeier DA, Peterson J. (1992) Variability among methods to assess patients’ well-being and consequent effect on a cost-effectiveness analysis. Journal of Clinical Epidemiology, 45:505–512.
Loomes G, McKenzie L. (1989) The use of QALYs in health care decision making. Social Science and Medicine, 28:299–308.
Culyer A, Lavers R, Williams A. (1971) Social indicators: health, in: Social Trends, No. 2 (Her Majesty’s Stationary Office, London).
Gudex C. (1986) QALYs and their use by the Health Service, Centre for Health Economics Discussion paper no. 20 (University of York).
Williams A. (1983) Applications in management, in G. Teely-Smith (ed.) Measuring Health: A practical approach. John Wiley, New York, 225–244.
Gafni A, Birch S. Equity considerations in utility-based measures of health outcomes in economic appraisals: an adjustment algorithm. Journal of Health Economics, 1991,10:329–342.
Feeny D, Torrance G. (1989) Incorporating utility-based quality-of-life assessment measures in clinical trials. Medical Care, 27:S190–204.
Birch S, Gafni A. (1992) Cost effectiveness/utility analyses: Do current decision rules lead us to where we want to be? Journal of Health Economics, 11:279–296.
Kaplan RM, Bush JW. (1982) Health related quality of life measurement for evaluating research and policy analysis. Health Psychology, 1:61–80.
Weinstein MC. (1986) Challenges for cost-effectiveness research. Medical Decision Making, 6:194–198.
Tubman TR, Halliday HL, Normand C. (1990) Cost of surfactant treatment for severe neonatal respiratory distress syndrome: a randomized controlled trial. British Medical Journal, 301:842–845.
Goel V, Detsky AS. (1989) A cost-utility analysis of preoperative total parenteral nutrition. International Journal of Technology Assessment in Health Care, 5:183–194.
Pickard JD, Bailey S, Sanderson H, Rees M, Garfield JS. (1990) Steps towards cost-benefit analysis of regional neurosurgical care. British Medical Journal, 301:624–635.
Johannesson M, Weinstein M. On the decision rules of cost-effectiveness analysis. Journal of Health Economics (in press).
Weinstein M, Zeckhauser R. Critical rations and efficient allocation. Journal of Public Economics. 1973; 2: 147–157.
Birch S, Gafni A. Changing the problem to fit the solution: Johannesson and Weinstein’s (mis)application of economics to real world problems. Journal of Health Economics (in press).
Gafni A, Birch S. Guidelines for the adoption of new technology: a potential prescription for uncontrolled growth in expenditures and how to avoid it. Canadian Medical Association Journal, 1993; 148:913–917.
Mehrez A, Gafni A. Quality-adjusted life-years, utility theory, and healthy years equivalents. Medical Decision Making, 1989, 9:142–149.
Mehrez A, Gafni A. Preference based outcome measures for economic evaluation of drug interventions: quality adjusted life years (QALYs) versus healthy years equivalents (HYE). PharmacoEconomics, 1992; 1:338–345.
Mehrez A, Gafni A. (1991) Healthy years equivalent: how to measure them using the standard gamble approach. Medical Decision Making, 11:140–146.
Gafni A. Using willingness-to-pay as a measure of benefits: what is the relevant question to ask in the context of public decision making about health care programs. Medical Care, 1991; 29:1246–1252.
Johannesson M, Johansson PO, Jonsson B. Economic evaluation of drug therapy: a review of the contingent valuation method. Pharmacoeconomics. 1992; 1:325–337.
Mishan EJ. Elements of cost-benefit analysis. London, London, 1972.
Baumol WJ. Economic theory and operations analysis. Englewood Cliffs, NJ. 3rd ed. Prentice Hall, 1972.
Russell LB. Opportunity costs in modern medicine. Health Affairs. 1992; 11:162–169.
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© 1996 Kluwer Academic Publishers
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Birch, S., Gafni, A. (1996). Cost-Effectiveness and Cost Utility Analyses: Methods for the Non-Economic Evaluation of Health Care Programmes and How We Can Do Better. In: Geisler, E., Heller, O. (eds) Managing Technology in Healthcare. Management of Medical Technology, vol 1. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-1415-8_4
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