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In healthcare there are many different types of decisions to be made.
For instance, we may need to decide across many programms which is
the most worthwhile, or which is the best mix of programmes. For
example, a health authority may have to decide on whether and at
what level to fund teenage health clinics or day centres for the
elderly. Alternatively, we may have already decided that something
is worth doing and we want to define the best way of achieving it.
For example, we will try and prevent an infectious disease either
by vaccination or by administering gammaglobulin. The conceptual
framework of economic evaluation differs according to the type of
decisions in question and the viewpoint of the decision-maker.
In health services, consequences of interventions are numerous and
complex. For instance there are preventive interventions which can
avoid the very onset of a disease (e.g. polio immunization), or
curative interventions which lengthen survival (cancer treatment),
others still that modify the quality of survival (pain relief) and
others that modify both (kidney transplants). Some interventions
can have negative effects or no effects. Some effects take place
both on the patient and his/her family or other patients, or in a
more indirect manner on society as a whole, for instance causing
productivity losses through sickness. Again, such losses can accrue
both to society, the patient or his/her family or carers and their
consequences are taken into account in economic evaluation to allow
comparison with inputs, as health economics is a science mainly
concerned with the bottom line: the total benefits or damage arising
from our actions. To provide health care interventions or programmes,
we need resources. Resources are all that society owns and uses to
provide such programmes. The same resources are not available for an
alternative use i.e. they can only be used once. Both tangible items
(equipment, premises, drugs, ambulances, materials) and intangible
items (time, knowledge and know-how) must be taken into account
regardless of whether they are used by and accrue to health services,
society, industry or the single individual. In order to make
comparisons between the options it is necessary to find a common unit
of value for each of the inputs, during and as a consequence of the
heath care intervention. If it is relevant for the type of evaluation
being conducted, the health consequences are also valued in common
units. Complete economic evaluations aim to clarify, quantify and
value all of the relevant options, and their inputs and consequences.
Cost-Benefit Analysis (CBA) falls into this category. Some
approaches fall short of full valuation of all consequences, but are
still considered to be economic evaluations. This includes most
Cost-Utility Analyses (CUA), Cost-Effectiveness Analyses (CEA) and
Cost-Minimisation Analyses (CMA). Many studies of use of resources
in health care do not make explicit comparisons between options for
care. These are not economic evaluations, but nevertheless can be
considered as economic studies and can contribute to our understanding.
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