Measures Of Costeffectiveness

An analysis of the ratio of the costs to the benefits of one intervention compared to another aims to establish both the value of an intervention and priorities for the allocation of resources. Measures of total direct and indirect costs, including future costs and benefits beyond the time of the intervention, may be operationally difficult and costly to obtain. For example, to fully determine the cost-effectiveness of an intervention such as outpatient day care for patients with MS or stroke, data about expenses ought to be collected for visits to physician's offices and emergency rooms, hos-pitalizations, pharmaceutical purchases such as antibiotics for bladder infections, and additional durable medical equipment. A bibliography of rehabilitation studies that includes a cost-effectiveness analysis is found at www.aapmr. org/memphys/cebfinala.htm. Types of cost analyses include cost effectiveness, cost benefit, cost minimization, cost utility, and length of stay.225 The Cochrane Database of Systematic Reviews (American College of Physicians, Philadelphia, PA) also includes several rehabilitation-related analyses.

Cost-effective analyses ought to include explicit statements about the following issues: the perspective of the analysis; benefits; cost data, including program and treatment costs; costs of adverse reactions; averted costs; induced costs; the use of discounting if the timing of costs and benefits differ; a sensitivity analysis; and summary measures.226

The meaning of an analysis of benefit is no better than its outcome measures of disability, QOL, or complications of receiving and not receiving an intervention. The interpretation of these analyses, whether a cost is worth the benefit, depends especially upon the particular culture's socioeconomic capabilities and health agenda.

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