Cost-Effectiveness and Quality of Life

Abstract

With increased availability of radiosurgical facilities and an increased need for accountability in an era of limited resources and managed care, there is growing interest in understanding the economic impact of such technologies and hence a need for a thorough economic appraisal. The key features pertaining to economic evaluations of medical interventions involve “inputs” that are compared with “outputs.” The inputs include direct costs of providing health care and indirect costs (e.g., production losses when patients are withdrawn from their work as a result of medical interventions). There are also other related and poorly measured intangible costs (although not strictly considered as “inputs”) such as pain and suffering, which may be associated with therapy [1]. Outputs include direct benefit in terms of savings in other direct medical care costs with intervention, the production gains from an earlier return to work, and intangible benefits such as the value of patients feeling better with therapy. Outputs have also been described in utility units (such as quality adjusted life years). The components of economic evaluation have been well summarized in Figure 66-1 adapted from Rutten and Drummond [1]. Explicit definitions of cost have been described by many authors [2]–[5] and are listed in Table 66-1.