Mosby's Complementary Alternative Medicine: A Research-Based Approach

By Lyn W. Freeman; G. Frank Lawlis | Go to book overview

Appendix A: Program Research Evaluation:
Methods and Statistical Overview
What methods demonstrate effectiveness (or ineffectiveness) of an alternative therapy program?In many ways, the evaluation of an alternative therapy is one of the most interesting issues of program analysis because of the nature of the design of the program. It is interesting to begin the evaluation of a program by asking each of the principal therapy participants the actual goals of the program and by determining a consensus. Too many times, there is great variance in the program administration's perception of the outcome goals and the perceptions of the practitioners.For example, in one evaluation in Arkansas, it was observed that the director, who wrote the grant for the program, had clear objectives for improving the quality of health in patients with cancer, specifically in the areas of reducing anxiety and depression. In contrast, the therapists collectively reported that the program outcome should improve family relations, which often revealed family dysfunction and exacerbated anxiety and depression.Although outcome criteria (e.g., pain reduction, vocational rehabilitation) are usually clear in the design of the program, many features cannot be measured and easily assessed at exit times. Beyond the obvious, some of the most widely used outcome criteria are the following:
1. Energy and activity levels
2. Functional abilities
3. Sleep and eating behaviors
4. Disease symptoms
5. Health status
6. Satisfaction with health (or health service delivery)
7. Sex life
8. Well-being
9. Psychologic effect (i.e., increased positive features, such as self-esteem, self control and/or decreased negative features, such as anxiety, stress)
10. Life satisfaction
11. Happiness
12. Ability to work
13. Employment status
14. Economic parameters (e.g., cost-effectiveness, cost minimization)

Economic Evaluation

Since many managed care organizations and insurance companies are now considering a range of therapies with varying costs and benefits, economic analyses are becoming a common feature not only with programs but with individual practitioners as well. Even the Food and Drug Administration (FDA) is unlikely to be the agency responsible for assuring cost-effectiveness, because this responsibility could potentially confuse the FDA's mandate of safety and efficacy. Many reasons underlie the current force to conduct economic analyses.

Such studies can be conducted from the perspectives of society as a whole, the payer, the provider, and the patient. These perspectives determine the types of costs and consequences included in the evaluation.

There are four basic types of economic approaches currently used in the market: cost minimization, cost effectiveness, cost utility, and cost benefit. Although the programs are not compared directly with concurrent ones, historical data are often used as standards. For example, many programs have conducted economic analyses for patients with back pain, comparing the costs of surgery and vocational rehabilitation if patients choose the route of aggressive surgery, as compared with the clinical costs of a more conservative approach.

Cost-minimization analyses are those variables that demonstrate that a program can reduce the costs of treatment, if one assumes that the health outcomes would be the same as a more aggressive and costly approaches. In the example of pain clinics, one could assume the probabilities of health consequences (from surveys reporting frequencies of return-to-work and reduction of pain), thereby offering some assurances of reduced costs to the insurance carrier. Cost‐ minimization approach is most common for pain clinics.

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