What is economic evaluation?
HTA is used to inform decision making to help build equitable and efficient health systems, in doing so assessment takes place across dimensions including clinical and economic considerations.
Using outputs, decision makers have to make policy and service decisions in an environment with ever increasing demands, with constrained resource. Furthermore, decision making doesn’t take place in a vacuum, with the evaluation of different and maybe competing options, based on their relative merit, including their health impact and resource implications.
It is this evaluation we call economic evaluation, the combined and complimentary evaluation of clinical and economic aspect. Defined as “the comparative analysis of alternative courses of action based on respective costs and consequences”.
With an increased focus on the cost of health care, more payer organisations have utilized economic evaluation in some way, although this varies depending on the role of different stakeholders and how care is funded.
There are different approaches to economic analysis including: Cost effectiveness analysis, cost utility analysis and cost benefit analysis. These all take a similar approach to the management of costs in their analysis but differ in the way consequences are measured and included.
- Cost effectiveness analysis uses natural units of health outcomes (e.g. a mean reduction in progression free survival)
- Cost utility analysis uses utility outcomes (e.g. QALYs)
- Cost benefit analysis uses monetary outcomes.
Payers usually favour either Cost effectiveness analysis or cost utility analysis.
From an evidence perspective, comparison is made based on costs and consequences therefore inputs for this reflect these. Clinical data from phase 3 studies is often used to estimate consequences and cost data for the whole intervention, not just acquisition, typically comes from a range of sources relevant for the context for the estimation of costs.
Other considerations will included be how generalisable the data is, how to address uncertainty in the data and if evidence needs to be synthesised to be used, or if new evidence needs to be generated to directly support the evaluation. In summary economic evaluation is the comparison of clinical and cost impacts across different options, is evidence in its own right but also relies upon different sources of evidence as inputs into the evaluation.
Briggs, A., Schulpher, M., & Claxton, K. (2006). Decision modelling for health economic evaluation. Oxford University Press.
Drummond, M., Sculpher, M.J., Claxton, K., Stoddart, G., Torrance, G., 2015. Methods for the economic evaluation of health care programmes, Forth. ed. Oxford University Press.