Principles and progress in healthcare cost analysis : applications to economic evaluations in COPD

Due to medicalisation, ageing of the population, and technological and pharmaceutical developments, \-\!estern countries have been confronted with a rapid increase in the costs of healthcare during the last decades. The armamentarium of the medical profession has grown enormously and medications have become available for diseases for which, until recently, treatment was not possible. These developments coincided with increasing pressure on budgets of national governments and the awareness that limits must be set to the growth of the costs of healthcare. Instead of the automatic influx of new technologies, the need arose to assess these technologies in terms of their costs and benefits in order to decide upon registration, reimbursement and pricing (Boer, 2002). These developments have led to a significant increase in the number and variety of economic evaluations in health care. Economic evaluations have been performed for many different kinds of health technologies, including organ transplantation, diagnostic devices and treatment with medicines. Economic evaluations \Vere either performed alongside prospective randomised controlled trials, as standalone studies based on retrospective data, or as modelling studies incorporating economic and clinical data from a variety of sources. \,Vith the increase of studies, several authors have expressed their worries about the quality and comparability of these economic evaluations.

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