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Cost-Utility Analysis

  • Mojca Z. Dernovsek
  • Valentina Prevolnik-Rupel
  • Rok Tavcar
Chapter

Abstract

Cost-utility analysis is a method which is most often used when benefits cannot be expressed in monetary (profit) or metric values (days of sick leave). The utilities in cost-utility analyses are in fact preferences of each person, a selected group, or the whole population. Since quality of life is one of the preferences, estimation of quality of life is frequently used in health economics. The results of cost-utility analyses are expressed in QALY – quality adjusted life years. QALY indicates the average number of years of quality life which a person with a defined health status will be able to live in a case that a certain intervention is carried out. This indicator therefore shows the cost of intervention with regard to a specific outcome, life in quality. In psychiatry the measurements of health outcome like survival, disability, sick leave, quality of life, satisfaction of clients, etc., were traditionally important but in the recent years the awareness of costs associated with any health intervention has grown. In studying mental disorders the situation seems somewhat specific since traditional outcome indicators do not always reflect the many (complex) faces of mental disorder. Although the methodology is appropriate to compare health economic issues of different mental disorders these studies are scarce, probably due to a complicated design. It is much easier to conduct an outcome study with a single diagnostic category. On the other hand there were many studies that were comparing costs and other outcomes of different preventive and therapeutic interventions in a single diagnostic category. The results of cost-utility analyses are useful in many situations: planning of service development, resource allocations, to find out the best available intervention for persons with a certain health status, etc.

This chapter provides a short introduction to economic analysis giving a special emphasis to a cost-utility analysis and defining its place among other methods in health economics. Beside theoretical considerations, several practical applications of cost-utility analysis using QALYs are discussed

Key words

Cost-utility analysis effectiveness QALY health States 

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References

  1. 1.
    Pyne JM, Patterson TL, Kaplan RM, et al. Preliminary longitudinal assessment of quality of life in patients with major depression. Psychopharmacol Bull 1997: 33 23–29.PubMedGoogle Scholar
  2. 2.
    Awad AG, Voruganti LN, Heslegrave RJ. A conceptual model of quality of life in schizophrenia: description and preliminary clinical validation. Qual Life Res 1997: 6 21–26.PubMedCrossRefGoogle Scholar
  3. 3.
    Katschnig H. How useful is the concept of quality of life in Psychiatry? In: Katschnig H, Freeman H, Sartorius N, eds. Quality of Life in Mental Disorders. Chichester: Wiley; 1997: 3–16.Google Scholar
  4. 4.
    Wiklund I, Karlberg J. Evaluation of quality of life in clinical trials: selecting quality-of-life measures. Control Clin Trials 1991; 12. 204S-216SPubMedCrossRefGoogle Scholar
  5. 5.
    Namjoshi MA, Rajamannar G, Jacobs T, et al. Economic, clinical, and quality-of-life outcomes associated with olanzapine treatment in mania: results from a randomized controlled trial. J Affect Disord 2002: 69 109–118.PubMedCrossRefGoogle Scholar
  6. 6.
    Peveler R, Kendrick T, Buxton M, et al. A randomised controlled trial to compare the cost-effectiveness of tricyclic antidepressants, selective serotonin reuptake inhibitors and lofepramine. Health Technol Assess 2005: 9 1–134.PubMedGoogle Scholar
  7. 7.
    WHO. Health Promotion. A discussion document on the concepts and principles. Copenhagen: WHO Regional Office of Europe, 1984Google Scholar
  8. 8.
    Weeks J. Taking quality of life into account in health economic analyses. J Natl Cancer Inst Monogr, 1996: 20 23–27.PubMedGoogle Scholar
  9. 9.
    Drummond FM, O’Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. 2nd edition. Oxford: Oxford Medical Publications; 1997: 1–305.Google Scholar
  10. 10.
    Revicki DA, Kaplan RM. Relationship between psychometric and utility-based approaches to the measurement of health-related quality of life. Qual Life Res 1993: 2 477–487.PubMedCrossRefGoogle Scholar
  11. 11.
    Revicki DA, Osoba D, Fairclough D, et al. Recommendations on health- related quality of life research to support labeling and promotional claims in the United States. Qual Life Res 2000: 9 887–900.PubMedCrossRefGoogle Scholar
  12. 12.
    Franz M, Meyer T, Gallhofer B. Are importance ratings useful in the assessment of subjective quality of life in schizophrenic patients? Int J Methods Psychiatr Res 1999: 8 204–211.CrossRefGoogle Scholar
  13. 13.
    Schwartz S, Richardson J, Glasziou PP. Quality-adjusted life years: origins, measurements, applications, objections. Aust J Public Health 1993: 17 272–278.PubMedCrossRefGoogle Scholar
  14. 14.
    Johannesson M, Jönsson B, Karlsson G. Outcome measurement in economic evaluation. Health Econ 1996: 5 279–296.PubMedCrossRefGoogle Scholar
  15. 15.
    Neumann PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu Rev Public Health 2000: 21 587–611.PubMedCrossRefGoogle Scholar
  16. 16.
    Jenkins DC. Assessment of outcomes of health intervention. Soc Sci Med 1992: 35 367–375.PubMedCrossRefGoogle Scholar
  17. 17.
    Revicki DA, Shakespeare A, Kind P. Preferences for schizophrenia – related health States: a comparison of patients, caregivers and psychiatrists. Int Clin Psychopharmacol 1996: 11 101–118.PubMedCrossRefGoogle Scholar
  18. 18.
    Revicki DA, Wu AW, Murray MI. Change in clinical status, health status, and health utility outcomes in HIV-infected patients. Med Care. 1995; 33 (4 Suppl):AS173–182.Google Scholar
  19. 19.
    Voruganti LNP, Awad AG, Oyewumi LK, Cortese L, Zirul S, Dhawan R. Assessing health utilities in schizophrenia. A feasibility study. Pharmacoeconomics 2000; 17:273–286CrossRefGoogle Scholar
  20. 20.
    Revicki DA, Wood M. Patient-assigned health State utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J Affect Disord 1998: 48 25–36.PubMedCrossRefGoogle Scholar
  21. 21.
    Revicki DA. Relationship between health utility and psychometric health status measures. Med Care 1992; 30 (5 Suppl): MS274–282.Google Scholar
  22. 22.
    Nease RF, Kneeland T, O’Connor GT, et al. Variation in patient utilities for outcomes of the management of chronic stable angina. Implications for clinical practice guidelines. Ischemic Heart Disease Patient Outcomes Research Team. JAMA 1995: 273 1185–1190.PubMedCrossRefGoogle Scholar
  23. 23.
    Patrick DL, Mathias SD, Elkin EP, et al. Health State preferences of persons with anxiety. San Francisco: Technology Assessment Group, 1995Google Scholar
  24. 24.
    Benett KJ, Torrance GW, Boyle MH, Guscott R, Moran LA. Development and testing of a utility measure for major, unipolar depression (McSad). Qual Life Res 2000: 9 109–120.CrossRefGoogle Scholar
  25. 25.
    Lenert LA, Morss S, Goldstein MK, Bergen MR, Faustman WO, Garber AM. Measurement of the validity of utility elicitations performed by computerized interview. Med Care 1997: 35 915–920.PubMedCrossRefGoogle Scholar
  26. 26.
    http://www.euroqol.orgGoogle Scholar
  27. 27.
    Torrance GW, Feeny DH, Furlong WJ, Barr RD, Zhang Y, Wang Q. Multiattribute utility function for a comprehensive health status classification system: Health Utilities Index Mark 2. Med Care, 1996: 34 702–722.PubMedCrossRefGoogle Scholar
  28. 28.
    Kaplan RM, Anderson JP. The general health policy model: an integrated approach. In: Spilker B (ed.): Quality of life and pharmacoeconomics in clinical trials. Philadelphia: Lippincott-Raven; 1996: 309–322.Google Scholar
  29. 29.
    Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med 2001: 33 328–336.PubMedGoogle Scholar
  30. 30.
    http://www.shef.ac.uk/scharr/sections/heds/mvh/sf-6dGoogle Scholar
  31. 31.
    Mehrez A, Gafni A. The healthy-years equivalents: how to measure them using the standard gamble approach. Med Decis Making 1991: 11 140–146.PubMedCrossRefGoogle Scholar
  32. 32.
    Ganiats TG, Browner DK, Kaplan RM. Comparison of two methods of calculating Quality-adjusted Life Years. Qual Life Res 1996: 5 162–164.PubMedCrossRefGoogle Scholar
  33. 33.
    Kaplan RM, Anderson JP, Ganiats TG. The quality of well-being scale: rationale for a single quality of life index. In: Walker SR, Rosser RM, eds. Quality of life assessment. Key issues in the 1990s. London: MTM Press, 1993: 65–94.Google Scholar
  34. 34.
    Gold MR, Siegal JE, Russell LB, Weinstein MC, eds. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996: 21–39.Google Scholar
  35. 35.
    Dernovsek MZ, Prevolnik Rupel V, Rebolj M, Tavcar R. The quality of life of schizophrenic outpatients, treated with depot neuroleptics. Eur Psychiatry 2001: 16 474–482.PubMedCrossRefGoogle Scholar
  36. 36.
    Gold MR, Patrick DL, Torrance GW, et al. Identifying and valuing outcomes. In: Gold MR, Russell LB, Weinstein MC, eds. Cost-effectiveness in Health and Medicine. New York: Oxford University Press; 1996: 82–134.Google Scholar
  37. 37.
    Kind P. Putting the “Q” into QALYs. Paper, presented at a conference Be reasonable: Following the Williams way – a conference to celebrate the work of Alan Williams. York, July 25–26., 2006Google Scholar
  38. 38.
    Raisch DW. Understanding Quality-adjusted Life Years and their application to pharmacoeconomic research. Ann Pharmacother 2000: 34 906–914.PubMedCrossRefGoogle Scholar
  39. 39.
    Patterson TL, Kaplan RM, Jeste DV. Measuring the effect of treatment in quality of life in patients with schizophrenia: focus on utility-based measures. CNS Drugs 1999: 12 49–64.CrossRefGoogle Scholar

Copyright information

© springer 2007

Authors and Affiliations

  • Mojca Z. Dernovsek
    • 1
    • 2
  • Valentina Prevolnik-Rupel
    • 3
  • Rok Tavcar
    • 1
    • 4
  1. 1.University Psychiatric HospitalSI-1260 Ljubljana-Polje
  2. 2.Institute of Public Health of Republic of SloveniaSlovenia
  3. 3.Ministry of Health of Republic of SloveniaSlovenia
  4. 4.School of Medicine, Chair of PsychiatryUniversity of LjubljanaSlovenia

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