Cost-Effectiveness in Health and Medicine

Description

A unique, in-depth discussion of the uses and conduct of cost-effectiveness analyses (CEAs) as decision-making aids in the health and medical fields, this volume is the product of over two years of comprehensive research and deliberation by a multi-disciplinary panel of economists, ethicists, psychometricians, and clinicians. Exploring cost-effectiveness in the context of societal decision-making for resource allocation purposes, this volume proposes that analysts include a "reference-case" analysis in all CEAs designed to inform resource allocation and puts forth the most explicit set of guidelines (together with their rationale) ever defined on the conduct of CEAs. Important theoretical and practical issues encountered in measuring costs and effectiveness, evaluating outcomes, discounting, and dealing with uncertainty are examined in separate chapters. Additional chapters on framing and reporting of CEAs elucidate the purpose of the analysis and the effective communication of its findings. Cost-Effectiveness in Health and Medicine differs from the available literature in several key aspects. Most importantly, it represents a consensus on standard methods--a feature integral to a CEA, whose principal goal is to permit comparisons of the costs and health outcomes of alternative ways of improving health. The detailed level at which the discussion is offered is another major distinction of this book, since guidelines in journal literature and in CEA-related books tend to be rather general--to the extent that the analyst is left with little guidance on specific matters. The focused overview of the theoretical background underlying areas of controversy and of methodological alternatives, and, finally, the accessible writing style make this volume a top choice on the reading lists of analysts in medicine and public health who wish to improve practice and comparability of CEAs. The book will also appeal to decision-makers in government, managed care, and industry who wish to consider the uses and limitations of CEAs. Content: Cover Page -- Title Page -- Copyright Page -- Foreword -- Acknowledgments -- Contents -- List of Contributors -- Introduction -- 1. Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations -- What Is the Appropriate Perspective? -- Defining Outcomes and Costs from the Societal Perspective -- CEA as an Aid to Decision Making -- Other Methods for Making Decisions in Health -- Results of CEA and Other Methods Compared -- Current and Potential Uses of CEA -- Conclusion -- Recommendations -- 2. Theoretical Foundations of Cost-Effectiveness Analysis. What is Cost-Effectiveness Analysis? -- Theoretical Foundations for Valuing Individual and Social Well-Being -- Theoretical Foundations for Valuing Costs in CEA -- Applications of Theory to methodologie Controversies -- Conclusion -- 3. Framing and Designing the Cost-Effectiveness Analysis -- Framing the Study -- Designing the Study -- Conclusion -- Recommendations -- 4. Identifying and Valuing Outcomes -- The Outcomes of Interest in Cost-Effectiveness Analysis -- Combining Duration of Life with Health-Related Quality of Life -- Health Status Measures -- Why Value Health Outcomes? Whose Preferences Should Be Used in CEA? -- Preference Classification Systems -- Techniques for Valuing Health States -- Toward Consistency Across Studies: A National Catalogue of Weights -- Recommendations -- Appendix 4.1: Generic Preference-Based Measures for Use in CEA -- 5. Assessing the Effectiveness of Health Interventions -- Definitions -- Sources of Data for Probability Estimates -- Modeling to Estimate Effectiveness in a CEA -- Calculation of Net Effectiveness -- Conclusion -- Recommendations -- 6. Estimating Costs in Cost-Effectiveness Analysis. A Graphic Illustration of Economic Consequences -- Types of Resource Costs -- Measurement and Valuation of Resources in Gross-Costing -- Conclusion -- Recommendations -- 7. Time Preference -- Discounting Costs -- Discounting Health Consequences -- Choosing the Discount Rate for CEA -- Recommendations -- Appendix 7.1: A Theoretical Model of Intertemporal Decision Making Regarding Health and Other Commodities -- Appendix 7.2: A Two-Stage Procedure for Incorporating Individual and Societal Time Preferences -- 8. Reflecting Uncertainty in Cost-Effectiveness Analysis -- Parameter Uncertainty. Modeling Uncertainty -- Recommendations -- 9. Reporting Cost-Effectiveness Studies and Results -- The Journal Report -- The Technical Report -- Disclosure -- Conclusion -- Recommendations -- Appendix A: Summary Recommendations -- Worked Examples -- Appendix B: Cost-Effectiveness of Strategies to Prevent Neural Tube Defects -- Appendix C: The Cost-Effectiveness of Dietary and Pharmacologic Therapy for Cholesterol Reduction in Adults -- Glossary -- Index.