Kosteneffectiviteitsanalyses over de keten vanpreventie, cure en care - Discussie van een raamwerk voor integrale kosteneffectiviteitsanalyse

摘要

Cost-effectiveness analyses (CEA) give important information about theefficiency of health care interventions. Consistent evaluation ofcost-effectiveness over the disease trajectory from prevention to caremay provide useful data to support health care priority setting.Health care budgets rank high in political concern and economicevaluations of health care programs may get to play an increasinglyimportant role. Yet the methods of cost-effectiveness analysis have alsobeen criticized.The current report examined the CEA methodology and its critiques, tofind a useful method for quantifying revenues and costs of interventionsover the complete trajectory from prevention to curative care. Themethod used was a discussion over selected methodological issues, puttingup a framework for application in future analyses.The big advantage of cost-effectiveness analysis is the request to gatherexplicit and consistent information. This information is then summarizedin the cost-effectiveness ratio. If practiced with due consideration,the results will provide decision makers with useful figures, despite theneed to make assumptions. Cost-effectiveness analyses, however, willsupport and not replace conscious decision making. The loss ofinformation implied by summarizing results in cost-effectiveness ratiosis a disadvantage. Furthermore, other arguments than costs andefficiency will play a role in health care priority setting. Toconclude, sensible use of economic evaluations requires decision makersto go beyond single cost-effectiveness ratios.