Financial problems of governments and the consequent urge to set limits on health care growth have increased the importance of economic rationalization. A systematic review of the present body of knowledge might facilitate the need to set priorities in health care policies and research in an ageing society with growing numbers of the elderly and chronically ill. After explaining the purpose and methods of full economic evaluation, we review the literature on 3 major chronic diseases, diabetes mellitus (20 publications), rheumatoid arthritis (15) and chronic obstructive pulmonary disease (COPD) and asthma (8). This review serves 2 objectives: to review the existing literature and to assess its quality. The review reveals a lack of full economic evaluation in this sector of health care. The total number of references to the specified chronic diseases covers 5% of all economic literature and 44% of all references under Index Medicus' heading 'economics', while the burden of illness is substantial, resulting in high indirect costs to the patients themselves and to society. The dominant approach is cost-effectiveness analysis (71%), followed by cost-benefit analysis (20%). Cost-utility analysis is rare (9%), partly because it is still in the phase of development. However, this approach can deal better with the objectives of many interventions in chronic care, i.e. increasing the quality rather than the quantity of life. We make a plea for full economic evaluation of chronic care programmes and for the development of quality of life measures which cover the broad domain of well-being of the chronically ill.

Chronic diseases, Chronic obstructive pulmonary disease and asthma, Diabetes mellitus, Full economic evaluation, Quality of life, Rheumatoid arthritis
dx.doi.org/10.1093/eurpub/5.1.8, hdl.handle.net/1765/65288
European Journal of Public Health
Erasmus School of Health Policy & Management (ESHPM)

Huijsman, R. (1995). Economic evaluation of care for the chronically ill: A literature review. European Journal of Public Health (Vol. 5, pp. 8–19). doi:10.1093/eurpub/5.1.8