Cost-Effectiveness in Health and Medicine

List of Contributors xv Introduction xvii Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations 3(22) What Is the Appropriate Perspective? 5(2) Defining Outcomes and Costs from the Societal Perspective 7(2) CEA as an Aid to Decision Making 9(3) Other Methods for Making Decisions in Health 12(1) Results of CEA and Other Methods Compared 13(5) Current and Potential Uses of CEA 18(3) Conclusion 21(1) Recommendations 21(4) Theoretical Foundations of Cost-Effectiveness Analysis 25(29) What is Cost-Effectiveness Analysis? 26(3) Theoretical Foundations for Valuing Individual and Social Well-Being 29(7) Theoretical Foundations for Valuing Costs in CEA 36(1) Applications of Theory to Methodologic Controversies 37(13) Conclusion 50(4) Framing and Designing the Cost-Effectiveness Analysis 54(28) Framing the Study 54(14) Designing the Study 68(11) Conclusion 79(1) Recommendations 79(3) Identifying and Valuing Outcomes 82(53) The Outcomes of Interest in Cost-Effectiveness Analysis 83(6) Combining Duration of Life with Health-Related Quality of Life 89(5) Health Status Measures 94(2) Why Value Health Outcomes? 96(2) Whose Preferences Should Be Used in CEA? 98(8) Preference Classification Systems 106(4) Techniques for Valuing Health States 110(9) Toward Consistency Across Studies: A National Catalogue of Weights 119(3) Recommendations 122(2) Appendix 4.1: Generic Preference-Based Measures for Use in CEA 124(11) Assessing the Effectiveness of Health Interventions 135(41) Definitions 137(4) Sources of Data for Probability Estimates 141(10) Modeling to Estimate Effectiveness in a CEA 151(12) Calculation of Net Effectiveness 163(4) Conclusion 167(1) Recommendations 168(8) Estimating Costs in Cost-Effectiveness Analysis 176(38) A Graphic Illustration of Economic Consequences 176(2) Types of Resource Costs 178(25) Measurement and Valuation of Resources in Gross-Costing 203(5) Conclusion 208(1) Recommendations 209(5) Time Preference 214(33) Discounting Costs 216(3) Discounting Health Consequences 219(11) Choosing the Discount Rate for CEA 230(3) Recommendations 233(14) A Theoretical Model of Intertemporal Decision Making Regarding Health and Other Commodities 236(2) A Two-Stage Procedure for Incorporating Individual and Societal Time Preferences 238(9) Reflecting Uncertainty in Cost-Effectiveness Analysis 247(29) Parameter Uncertainty 248(19) Modeling Uncertainty 267(3) Recommendations 270(6) Reporting Cost-Effectiveness Studies and Results 276(28) The Journal Report 277(19) The Technical Report 296(3) Disclosure 299(1) Conclusion 300(1) Recommendations 301(3) Appendix A: Summary Recommendations 304(9) Worked Examples 312(1) Appendix B: Cost-Effectiveness of Strategies to Prevent Neural Tube Defects 313(36) Appendix C: The Cost-Effectiveness of Dietary and Pharmacologic Therapy for Cholesterol Reduction in Adults 349(43) Glossary 392(21) Index 413