Health economics: Basic principles and application in mental health

Abstract

The list below summarizes the stages of a typical economic evaluation. All stages need to be considered and carried out in order to obtain a valid and reliable set of findings. (1) Perspective or scope: identification of the essential category of the costs and outcomes that must be included. (2) Design: definition of the alternative interventions to be evaluated (experimental or observational), and duration of the intervention (16-week clinical trial or 1-year longitudinal study). (3) Mode of evaluation: CMA, CEA, CCA, CUA, or CBA. (4) Data collection: costs (direct provision of health and social care, social opportunity costs, lost productivity, carer costs, other public sector costs) and outcomes (long-term clinical effectiveness such as morbidity and mortality with patient self-assessed health state or interviewer-assessed health state). (5) Valuation: quantification of these identified costs and outcomes and further consideration of social weight. (6) Analysis: comparison of costs and outcomes (i.e. ICER). (7) Qualification: revision of findings in the light of risk, uncertainty and sensitivity. Methodological debates on various aspects of economic evaluation, such as the alternative techniques available for measuring health state preferences, are still continuing. In this context it is worth noting that economic evaluation is no panacea for making the 'right' decision when having to allocate scarce resources; rather, it is an additional tool that can facilitate explicit, evidence-based decision-making. © 2006 International Psychogeriatric Association.