An Introduction to Economic Evaluation: What's in a Name?

By Hoch, Jeffrey S.; Dewa, Carolyn S. | Canadian Journal of Psychiatry, March 2005 | Go to article overview

An Introduction to Economic Evaluation: What's in a Name?


Hoch, Jeffrey S., Dewa, Carolyn S., Canadian Journal of Psychiatry


Objective: This paper describes the main types of economic evaluation techniques.

Method: To examine the strengths and limitations of different types of economic evaluations, we used a hypothetical example to review the reasoning underlying each method and to illustrate when it is appropriate to use each method.

Results: The choice of economic evaluation method reflects a decision about what should represent "success" and how success should be valued. Measures of benefit and cost must be considered systematically and simultaneously. Claiming that a new treatment is cost-effective requires making a value judgment based on the personal beliefs of the claimant. Even when cost and effect data are objective, a verdict of cost-effective is subjective. The conclusions of an economic study can change significantly, depending on which patient outcome is used to measure success.

Conclusions: Clinicians must be sure that important patient outcomes are not excluded from economic evaluations. Economic evaluation is a process designed to produce an estimate rather than a decision. New treatment can be more costly and still be cost-effective (if the extra benefit is valued more than the extra cost to produce it). However, since economic evaluation does not explicitly consider a decision maker's available budget, a new treatment can be deemed cost-effective but too expensive to approve.

(Can J Psychiatry 2005;50:159-166)

Key Words: cost-effectiveness, cost-benefit, teaching economic evaluation, health economics

There has been unprecedented progress in health care during the past few decades. However, as Clare Booth Luce once quipped, "No good deed goes unpunished." We face the myriad innovations before us with scarce resources (such as money, time, and personnel). Thus progress has also left us with difficult choices. Insatiable demands for new treatments and services compel society to make difficult choices.

How should the choices be made? It has been suggested that "methods such as 'what we did last time,' 'gut feelings,' and even 'educated guesses' are not always better than organized consideration of the factors involved in a decision to commit resources to one use instead of another" (1). As a result, economic evaluation methods have been developed to help inform difficult choices by simultaneously considering costs and consequences of treatment interventions.

Many of the methods' names have become familiarcost-benefit analysis (CBA), cost-effectiveness analysis (CEA), and cost-utility analysis (CUA). Unfortunately, their meanings have not. When is CUA preferred to CBA? Can something be more costly and still be cost-effective? It is clear from the names of these economic evaluations that cost plays a prominent role. However, it is not as widely appreciated that the defining aspect of an economic evaluation has nothing to do with cost; it is how patient outcomes are treated that distinguishes one method from another.

This paper describes the main types of economic evaluation techniques. We examine their strengths and limitations from theoretical and applied perspectives. Using a hypothetical example, we also review the reasoning underlying each method and consider how this can be used to decide when it is appropriate to use each method.

The Relativity of it All

Once an investigator decides to incorporate an economic evaluation into a study, an appropriate comparator must be identified. To use a manufacturing metaphor, the new treatment or intervention under study and its comparator(s) are competing factories with different production processes. When measuring the economic efficiency of each "factory," costs must be compared, relative to some measure of "output." In health services, the "output" is patient outcome or treatment effectiveness.

We use a hypothetical case as a vehicle for our discussion. Suppose a research team has been asked to evaluate a novel program of assertive community treatment (PACT) for homeless people with severe and persistent mental illness. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

An Introduction to Economic Evaluation: What's in a Name?
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.