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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.
Key words
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© 1997 Published by Elsevier Inc.
