[:pb]The cost-effectiveness analysis (ACE) is currently the most suitable economic evaluation methodology to compare two or more healthcare technologies in order to choose the one that will bring more benefits, preferably at the lowest cost. Used in , Healthcare Technology Assessments (HTA)cost-effectiveness analysis (ACE) began to be adopted in the 1970s in developed countries and became a powerful instrument for technology incorporation processes at a time when the sector health sector faces the challenge of allocating the available resources in the best way, which are often scarce.

It is important to emphasize that cost-effectiveness analysis (ACE) is not just about choosing the cheapest option, but based on real-world data to weigh clinical information against costs and then, based on objective information, arrive at the most affordable option indicated according to the two criteria. Read below.

What does cost-effectiveness analysis (ACE) consist of?

In the context of economic studies for the incorporation of healthcare technologies, effectiveness is understood as the benefit observed in the real world and, by efficiency, the benefit weighted by cost. In this scenario, cost-effectiveness analysis (CEA) uses efficiency as an instrument to analyze the value of healthcare interventions, and “value” here is used in a broad context, which goes beyond the financial factor, but which also considers the real contribution of the technologies studied for individuals.

Thus, for a cost-effectiveness analysis (ACE) to fulfill its purpose, the analyzed data must always be objective:

• Costs: are measured in currency units;
• Clinical outcomes: are measured in clinical units, such as mortality, avoided hospitalizations, years of life gained, etc.

The final ACE index, therefore, is expressed as the “cost per clinical unit of success”, as the cost-per-death averted or per-day-without-pain. It is from these data, calculated based on objective information of financial values and observation of the real world, that it will be possible to compare two or more healthcare technologies with a basis for decision making.

Process Steps

In order to gather objective data, which can well support the calculations and, finally, the decision-making, the cost-effectiveness analyzes must follow some basic steps:

Definition of the survey question

In order for cost-effectiveness analysis (ACE) to generate objective data, it is necessary to know from the outset what you want to answer. The formulation of the research question will outline the entire study, and an error in this phase could compromise the final result.

Choice of healthcare technologies to be studied

This selection should be made focusing the research question and based on a review of the existing literature.

Definition of the analysis perspective

At this stage, the stakeholder interested in the study response is indicated, which will define the point-of-view of the analysis. For example: if the interested party is the Unified Health System (SUS) or the supplementary healthcare system, the study must come from different perspectives.

Selection of outcomes

The desired clinical outcomes are defined, whether they are final (such as death or heart attack) or intermediate (such as laboratory or imaging tests). A commonly used endpoint in cost-effectiveness analysis (ACE) is the DALY (Disability Adjusted Life Years Lost). DALY considers other indices (years of life lost due to premature death and years lost due to disability) to measure the burden of disease.

Selection of cost categories

At this stage, direct and indirect costs are considered. This can be more complex than you think, especially the closer you try to approximate estimates of what happens in the real world, with all its variables.

Results

They are presented through the ratio between the differences in cost and effectiveness of the healthcare technologies studied, translated by the ICER indicator (incremental cost-effectiveness ratio).

Sensitivity analysis

It is a technique to assess uncertainty about any variable involved in the study, whether in relation to costs or clinical outcomes, with the objective of proving the robustness of the results of the cost-effectiveness analysis (CEA).

Calculation Models

The calculations of costs and benefits made in cost-effectiveness analysis (ACE) can be performed by different models. Among them are the decision tree, Markov models, Monte Carlo simulations, Bayesian methods, and others. All these models must be based on knowledge of the natural history of the disease and the action of therapeutic alternatives over time.

Do you want to know more about cost-effectiveness analysis and other forms of economic evaluation in the process of incorporating health technologies? Then download e-book MAPES: Cases &Soluções.[:]