[:pb] Health economics assessments began to be used in the 1960s, with the aim of evaluating and comparing existing information on different technologies in order to make decisions about the best way to allocate resources. Since then, there has been a progressive development of methodologies in the area, making this type of analysis increasingly relevant in technology incorporation processes in the sector – both in the public and private healthcare system.

Depending on the objective, these studies may follow different techniques and are based on the analysis of the costs necessary to support a given technology and on the expected healthcare outcomes.

Economic evaluations can also evaluate a single technology or make it possible to compare two or more available alternatives. In this article, we will especially address two of the main instruments used: cost-effectiveness and cost-utility analysis.

The main economic valuation techniques

Today there are basically three techniques used to carry out economic evaluations: cost-effectiveness, cost-effectiveness and cost-utility. Although they use microeconomic tools to investigate and calculate costs and other indicators, all three seek to serve a macroeconomic purpose, helping to make decisions about the best way to allocate resources in the healthcare sector. Let’s get to know each of them below.

Cost-benefit

The cost-benefit methodology is used to evaluate social projects, whether in the healthcare area or not. This instrument allows a single project or more than one to be analyzed for comparison purposes. The objective of this type of study is to evaluate the costs of the healthcare technology to be incorporated, in relation to the benefit it can provide.

Cost-effectiveness

The cost-effectiveness analysis technique assesses the costs involved in incorporating the technology and its performance towards meeting pre-established goals and targets. In short, it intends to define the best strategy to achieve the desired end. The cost-effectiveness analysis is always comparative, evaluating different solutions for the same objective, in order to choose the most appropriate.

In summary, the cost-effectiveness analysis process is based on the following steps:

• Goal definition and quantification;
• Definition of possible strategies to reach the goal;
• Identification and survey of the costs of each strategy;
• Identification and calculation of the effectiveness of different strategies;
• Analysis of the cost, effectiveness and cost-effectiveness of each of the strategies;
• Sensitivity analysis.

It is important to emphasize that, unlike the cost-benefit analysis, the cost-effectiveness methodology works based on an effect to be achieved, and not focused on a specific project.

This instrument, however, still leaves out important variables, such as political and cultural aspects that are also important. Therefore, cost-effectiveness analysis should not be the only technique used in the process of incorporating health technologies.

Cost-utility

The cost-utility technique can be understood as a more elaborate cost-effectiveness analysis focused on the duration and quality of survival. Thus, it is fundamentally used in the comparison of solutions for chronic patients. The unit used in the study is the cost/survival ratio, and survival is calculated by a specific unit, the QUALY or Quality Adjusted Life Year, which considers the time and quality of life provided by each intervention analyzed.

Cost-utility studies require a step prior to other cost-effectiveness studies, which consists of surveying existing QUALYS for each type of technology and health status. This phase requires considerable work, with research being carried out with patients who have already undergone procedures with these technologies, in which they give a grade to the quality of their survival after the intervention. Another point is that there are no established metrics for Brazilian society, requiring the use of international data.

Situations of use of different techniques

Cost-effectiveness

An example of the use of cost-effectiveness analysis is in the evaluation of different vaccination strategies, with the objective of establishing universal coverage, evaluating routine, and mass or according to the costs and effectiveness of each vaccination system.

Cost-utility

Due to the additional work needed with previous research, cost-utility studies are usually applied to treatments with high-cost and little-known impact on patient survival. An example is treatments for coronary heart disease, such as pacemaker implantation and heart transplantation.

To learn more about economic evaluations in the process of incorporating health technologies, download the MAPES e-book:MAPES: Cases &Soluções.[:]