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Economic constraints are a reality in the European healthcare environment. Because it is impossible to adopt all potentially effective treatments without destabilising national welfare systems, the costs of different treatments have been considered when making decisions in hospitals and healthcare administrations. However, this has often been done implicitly, intuitively, or with suboptimal information. Today, economic evaluations are attracting increasing attention. Their aim is to consider the overall picture of costs and effectiveness associated with different treatments. The essential parts of an economic evaluation are an estimate of the additional costs incurred by one treatment over another and the formal comparison of these additional costs with the corresponding gain in effectiveness. Information on effectiveness should preferably come from large, prospective, randomised trials with sufficient external validity. Cost information is usually retrieved from various secondary data sources. A cost equals the amount of a resource used, multiplied by its unit price. Ideally, key data on resource use should be collected from the clinical trials providing effectiveness data. This approach requires close collaboration among clinicians, statisticians, and health economists in all phases of the trial process, including the design of the protocol. When economic evaluations result from a multidisciplinary approach and are systematically integrated into the whole clinical research process for all important new treatments, they become a powerful tool. They may assist decision makers on all levels to allocate scarce healthcare resources in a rational and optimal way, thereby allowing optimal gains in life expectancy and quality of life within budgetary limits.
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