Complementary analyses in economic evaluation of health care

The steady increase in health care costs and the continuous emergence of new medical technologies have forced policy makers in health care to reconsider the current resource allocation and to become more selective with investing in new health care programs. Economic evaluations can support the decision making process, by providing systematic information on the costs and the consequences for health of investing in alternative health care programs. Needless to say, economic evaluations of health care should be methodologically sound, the outcomes should be relevant for health policy and comparable to results of studies concerning other health care programs. With respect to the policy relevance it is important that the aggregation level of the analysis matches the specificity of the policy question: a study of costs and health effects of for example air pollution control will not need to be as detailed as an analysis of the cost-effectiveness of cimetidine versus surgery in peptic ulcer. Economic evaluations may never become entirely comparable, but incomparabilities due to different methodologies can be reduced considerably. This raises two questions: - what is the appropriate level of aggregation in the economic evaluation of health care? - which cost items are to be included in economic evaluations and how should these be measured and valued, in particular the indirect costs of disease?