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Estimating Costs in the Economic Evaluation of Medical Technologies

Published online by Cambridge University Press:  10 March 2009

Bryan R. Luce  and
Anne Elixhauser
Bryan R. Luce
Affiliation:
Battelle
Anne Elixhauser
Affiliation:
Battelle
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Extract

The complexities and nuances of evaluating the costs associated with providing medical technologies are often underestimated by analysts engaged in economic evaluations. This article describes the theoretical underpinnings of cost estimation, emphasizing the importance of accounting for opportunity costs and marginal costs. The various types of costs that should be considered in an analysis are described; a listing of specific cost elements may provide a helpful guide to analysis. The process of identifying and estimating costs is detailed, and practical recommendations for handling the challenges of cost estimation are provided. The roles of sensitivity analysis and discounting are characterized, as are determinants of the types of costs to include in an analysis. Finally, common problems facing the analyst are enumerated with suggestions for managing these problems.

Type
Special Section: Alternative Methods for Assessing Technology, Part II
Information
International Journal of Technology Assessment in Health Care , Volume 6 , Issue 1 , January 1990 , pp. 57 - 75
Copyright
Copyright © Cambridge University Press 1990

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References

Altman, D. G., Flora, J. A., Fortmann, S. P., & Farquhar, J. W.The cost-effectiveness of three smoking cessation programs. American Journal of Public Health, 1987, 77, 162–65.CrossRefGoogle ScholarPubMed
Birch, S., & Donaldson, C.Applications of cost-benefit analysis to health care. Journal of Health Economics, 1987, 6, 211–25.CrossRefGoogle ScholarPubMed
Boyle, M. H., Torrance, G. W., Sinclair, J. C., & Horwood, S. P.Economic evaluation of neonatal intensive care of very-low-birth-weight infants. New England Journal of Medicine, 1983, 308, 1330–37.CrossRefGoogle ScholarPubMed
Dao, T. D.Cost-benefit and cost-effectiveness analysis of drug therapy. American Journal of Hospital Pharmacy, 1985, 42, 791–802.Google ScholarPubMed
Drummond, M. F., Smith, T. G., & Wells, N.Economic evaluation in the development of medicines. London: Office of Health Economics, 1988.Google Scholar
Drummond, M. F., & Shannon, H. S.Economic aspects of risk assessment in clinical safety. Science of the Total Environment, 1986, 51, 8 81–124.CrossRefGoogle Scholar
Drummond, M. F. Methods for economic appraisal of health technology. In Drummond, M. F. (ed.), Economic appraisal of health technology in the European Community. Oxford: Oxford University Press, 1987, 15–47.Google Scholar
Drummond, M. F.Principles of economic appraisal in health care. Oxford: Oxford University Press, 1980.Google Scholar
Eisenberg, J. A., & Kitz, D. S.Savings from outpatient antibiotic therapy for osteomyelitis: Economic analysis of a therapeutic strategy. Journal of the American Medical Association, 1986, 255, 1584–88.CrossRefGoogle ScholarPubMed
Eisenberg, J. A.New drugs and clinical economics: analysis of cost effectiveness in the assessment of pharmaceutical innovations. Review of Infectious Diseases, 1984, 6(suppl), S905–08.CrossRefGoogle ScholarPubMed
Eisenberg, J. M., Glick, H., Hillman, A. L. et al. Measuring the economic impact of penoperative total parenteral nutrition: Principles and design. American Journal of Clinical Nutrition, 1988, 47, 382–91.CrossRefGoogle Scholar
Evans, R. W., Manninen, D. L., Overcast, T. D. et al. The National Heart Transplantation Study: Final report. Seattle, WA: Battelle Human Affairs Research Centers, 1984.Google Scholar
Finkler, S. A.The distinction between cost and charges. Annals of Internal Medicine, 1982, 96, 102–09.CrossRefGoogle ScholarPubMed
Garrison, L. P. Overview of cost analysis. In Evans, R. W. et al. (eds.), The National Heart Transplantation Study: Final report. Seattle, WA: Battelle Human Affairs Research Centers, 1984, 27, 1–21.Google Scholar
Guyatt, G., Drummond, M., Feeny, D. et al. Guidelines for the clinical and economic evaluation of health care technologies. Social Science and Medicine, 1986, 22, 393–408.CrossRefGoogle ScholarPubMed
Hallstrom, A., Eisenberg, M. S., & Bergner, L.Modeling of the effectiveness and cost- effectiveness of an emergency service system. Social Science and Medicine, 1981, 15, 13–17.Google Scholar
Hodgson, T. A., & Meiners, M. R.Cost-of-illness methodology: A guide to current practices and procedures. Milbank Memorial Fund Quarterly/Health and Society, 1982, 60, 429–57.CrossRefGoogle ScholarPubMed
Kupperman, M., Luce, B. et al. An analysis of the cost-effectiveness of the implantable cardiac defibrillator. Circulation, 1990, 81, 91–100.CrossRefGoogle Scholar
Lannin, D. R., Silverman, J. F., Pories, W. J., & Walker, C.Cost-effectiveness of fine needle biopsy of the breast. Annals of Surgery, 1986, 203, 474–80.CrossRefGoogle ScholarPubMed
Lubeck, D. P., Spitz, P. W., Fries, J. F. et al. A multicenter study of annual health service utilization and costs in rheumatoid arthritis. Arthritis and Rheumatism, 1986, 29, 488–93.CrossRefGoogle ScholarPubMed
Luce, B.The implications of cost-effectiveness analysis of medical technology. Background paper #1: Methodological issues and literature review. Washington, DC: Office of lèchnology Assessment, 1980.Google Scholar
Mathews, A. & Bailie, G. R.Clinical pharmacokinetics, toxicity, and cost-effectiveness analysis of aminoglycosides and aminoglycoside dosing services. Journal of Clinical Pharmacology and Therapeutics, 1987, 12, 273–91.CrossRefGoogle ScholarPubMed
Muller, A., & Reutzel, T. J.Willingness to pay for reduction in fatality risk: An exploratory survey. American Journal of Public Health, 1984, 74, 808–12.CrossRefGoogle ScholarPubMed
Oster, G., Tuden, R. L., & Colditz, G. A.Prevention of venous thromboembolism after general surgery: Cost-effectiveness analysis of alternative approaches to prophylaxis. American Journal of Medicine, 1987, 82, 889–99.CrossRefGoogle ScholarPubMed
Oster, G., & Epstein, A. M.Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease: The case of cholestyramine. Journal of the American Medical Association, 1987, 258, 2381–87.CrossRefGoogle ScholarPubMed
Petitti, D. B.Competing technologies: Implications for the costs and complexity of medical care. New England Journal of Medicine, 1986, 315, 1480–83.CrossRefGoogle ScholarPubMed
Russell, L.Evaluating preventive care. Washington, DC: Brookings Institute, 1987.Google Scholar
Schoenbaum, S. C., McNeil, B. J. & Kavet, J.The swine-influenza decision. New England Journal of Medicine, 1976, 295, 759–65.CrossRefGoogle ScholarPubMed
Snider, D. E., Caras, G. J., & Koplan, J. P.Preventive therapy with isoniazid. Journal of the American Medical Association, 1986, 255, 1579–83.CrossRefGoogle ScholarPubMed
Simon, D. G.A cost-effectiveness analysis of cyclosporine in cadaveric kidney transplantation. Medical Decision Making, 1986, 6, 199–207.CrossRefGoogle ScholarPubMed
Sinclair, J. C., TorranceG. W., G. W.,Boyle, M. H. et al. Evaluation of neonatal intensive care programs. New England Journal of Medicine, 1981, 305, 489–94.CrossRefGoogle ScholarPubMed
Stason, W. B.Economics in hypertension management: Cost and quality trade-offs. Journal of Hypertension, 1987, 5(suppl.), S55–59.Google ScholarPubMed
Stason, W. B., & Weinstein, M. C.Public-health rounds at the Harvard School of Public Health. New England Journal of Medicine, 1977, 296, 732–46.CrossRefGoogle ScholarPubMed
Torrance, G. W., & Zipursky, A.Cost-effectiveness of antepartum prevention of Rh immunization. Clinics in Perinatology, 1984, 11, 267–81.CrossRefGoogle ScholarPubMed
Torrance, G. W., Stoddart, G. L., Drummond, M. F., & Gafni, A.Cost-benefit analysis versus cost-effectiveness analysis for the evaluation of long-term care programs. Health Services Research, 1981, 16, 474–76.Google ScholarPubMed
Van, Citters R. L., Bauer, C. B., Christopherson, L. K. et al. , Artificial heart and assist devices: Directions, needs, costs, societal, and ethical issues. Artificial Organs, 1985, 9, 375–415.Google Scholar
Warner, K. E., & Luce, B. R.Cost-benefit and cost-effectiveness analysis in health care: Principles, practice, and potential. Ann Arbor, MI: Health Administration Press, 1982.Google Scholar
Washington, A. E., Browner, W. S., & Korenbrot, C. C.Cost-effectiveness of combined treatment for endocervical gonorrhea. Journal of the American Medical Association, 1987, 257, 2056–60.CrossRefGoogle ScholarPubMed
Weinstein, M. C., & Stason, W. B.Foundations of cost-effectiveness analysis for health and medical practices. New England Journal of Medicine, 1977, 296, 716–21.CrossRefGoogle ScholarPubMed
Weinstein, M. C., & Stason, W. B.Cost-effectiveness of interventions to prevent or treat coronary heart disease. Annual Review of Public Health, 1985, 6, 41–63.CrossRefGoogle ScholarPubMed
Weinstein, M. C., Read, J. L., MacKay, D. N. et al. , Cost-effective choice of antimicrobial therapy for serious infections. Journal of General Internal Medicine, 1986, 1, 351–63.CrossRefGoogle ScholarPubMed
Weinstein, M. C., & Stason, W. B.Cost-effectiveness of coronary artery bypass surgery. Circulation, 1982, 66(suppl. III), 52–66.Google ScholarPubMed
Weisbrod, B. A., Test, M. A., & Stein, L. I.Alternative to mental hospital treatment II. Economic benefit-cost analysis. Archives of General Psychiatry, 1980, 37, 400–05.CrossRefGoogle ScholarPubMed
Woodward, E. G., & Drummond, M. F.Cost effectiveness in a hospital contact lens department. Ophthalmic Physiology and Optometry, 1984, 2, 161–67.CrossRefGoogle Scholar
Zeckhauser, R.Procedures for valuing lives. Public Policy, 1975, 23, 419–64.Google ScholarPubMed