Methods and Statistical Overview
|1.||Energy and activity levels|
|3.||Sleep and eating behaviors|
|6.||Satisfaction with health (or health service delivery)|
|9.||Psychologic effect (i.e., increased positive features, such as self-esteem, self control and/or decreased negative features, such as anxiety, stress)|
|12.||Ability to work|
|14.||Economic parameters (e.g., cost-effectiveness, cost minimization)|
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.