Economic Evaluation of Health Care for Chronic Diseases

Summary

The economic evaluation of health care services for chronic disease is an imperative borned of the fact that resources are finite; that technologic capacity and the public’s demand for them have increased, and that choices are inevitable and difficult. Economic evaluation is an explicit and quantitative technique to provide qualitative assistance to those who must decide among competing uses of resources in situations of uncertainty. The forms of economic evaluation, cost of illness, cost minimization, cost-effectiveness, cost-benefit and cost-utility analyses are defined.

The economic evaluation paradigm has many methodological and conceptual problems for chronic disease. Until recently no methodological standards existed. Even with these the identification and assessment of costs, the measurement of health benefits and the valuation of health benefits — key elements — remain unstandardized. Valuation research attempts to quantitate the utilities of health states but some groups (the elderly, the uneducated, minorities) cannot deal with the questions posted and implies that their perceptions are selectively excluded from studies that will inform health policy. Chronic rheumatic disease are lifelong. All areas of function can be affected and the types of interventions, medical surgical, rehabilitation, psychosocial, vocational, are varied in their application over time and in intensity. Economic studies are short term and focused on single interventions- all inappropriate for chronic disease. In the final analysis, like it or not, the question of what health care is worth societal investment is debated in every organized system of health care delivery. This should not be done nor interpreted by only a part of the stakeholders, nor without empirical data and the input of providers, patients and potential patients.