Cost accounting in cost utility analysis of screening and treatment
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《英国眼科学杂志》
Correspondence to:
Giedrius Vanagas
Kaunas University of Medicine, Department of Preventive Medicine, Eiveniu 4, Kaunas 50009, Lithuania; vanagas@kmu.lt
Accepted for publication 7 July 2004
Keywords: cost utility analysis; screening; treatment
I would like to make some comments regarding the cost utility analysis in the paper by Hopley et al1 because it is important to understand that the costs should be accounted at the same time and with the same degree of accuracy as outcome data. The economic definition of costs should be used in cost valuation, not the financial definition.2–5 The concept implies that all resources consumed by an intervention should be valued, not just those constituting a budgetary line item.
All methods (that is, cost effectiveness, cost minimisation, cost utility, and cost benefit) of economic evaluation in health care have one principle in common: they examine one or more possible interventions and compare the inputs or resources necessary to carry out such interventions with their consequences or effects.6 Cost utility analysis aimed to compare different interventions in terms of both quantity and quality of life; we express them as utilities. In this case, competing interventions are compared in terms of cost per utility (for example, cost per QALY).6,7 Values of resources in the cost utility analysis are assigned by defining costs. In accounting costs both tangible items (for example, equipment, drugs, materials, money etc) and intangible items (for example, time and treatment mode) must be taken into account, regardless of whether they are used by and accrue to health services, society, or the single individual.6 Costs for some resources may vary because of market forces—for example, rent, exploitation, so it is important to present results not only in monetary terms but also in quantity of resources used.
To allow comparability across different interventions, a 3% discount rate must be used as recommended by most guidelines if economic evaluations are made at different times.7
While this is increasingly becoming the practice, most studies have either attempted to estimate costs for alternative therapies retrospectively or, using literature reviews, budgetary line items and healthcare insurance costs sheets. This should be avoided from economic evaluations because it mainly reflects on budgetary formulations and has very little in common with the real cost of intervention.
References
Hopley C, Salkeld G, Wang J J, et al. Cost utility of screening and treatment for early age related macular degeneration with zinc and antioxidants. Br J Ophthalmol 2004;88:450–4.
Johns B, Baltussen R, Hutubessy R. Programme costs in the economic evaluation of health interventions. Cost Effectiveness and Resource Allocation 2003;1:1.
Little IMD, Mirrlees JA. Project appraisal and planning for developing countries. London: Heinemann Educational Books, 1974.
Mishan EJ. Cost-benefit analysis. 3rd ed. London: George Allen & Unwin (Publishers) Ltd, 1982.
Adam T, Koopmanschap MA. Cost-effectiveness analysis: can we reduce variability in costing methods? Int J Technol Assess Health Care 2003;19:407–20.
Jefferson T, Demicheli V, Mugford M .Elementaryeconomic evaluation in health care. 2nd ed. London: BMJ Books, 2000.
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997.(Giedrius Vanagas)
Giedrius Vanagas
Kaunas University of Medicine, Department of Preventive Medicine, Eiveniu 4, Kaunas 50009, Lithuania; vanagas@kmu.lt
Accepted for publication 7 July 2004
Keywords: cost utility analysis; screening; treatment
I would like to make some comments regarding the cost utility analysis in the paper by Hopley et al1 because it is important to understand that the costs should be accounted at the same time and with the same degree of accuracy as outcome data. The economic definition of costs should be used in cost valuation, not the financial definition.2–5 The concept implies that all resources consumed by an intervention should be valued, not just those constituting a budgetary line item.
All methods (that is, cost effectiveness, cost minimisation, cost utility, and cost benefit) of economic evaluation in health care have one principle in common: they examine one or more possible interventions and compare the inputs or resources necessary to carry out such interventions with their consequences or effects.6 Cost utility analysis aimed to compare different interventions in terms of both quantity and quality of life; we express them as utilities. In this case, competing interventions are compared in terms of cost per utility (for example, cost per QALY).6,7 Values of resources in the cost utility analysis are assigned by defining costs. In accounting costs both tangible items (for example, equipment, drugs, materials, money etc) and intangible items (for example, time and treatment mode) must be taken into account, regardless of whether they are used by and accrue to health services, society, or the single individual.6 Costs for some resources may vary because of market forces—for example, rent, exploitation, so it is important to present results not only in monetary terms but also in quantity of resources used.
To allow comparability across different interventions, a 3% discount rate must be used as recommended by most guidelines if economic evaluations are made at different times.7
While this is increasingly becoming the practice, most studies have either attempted to estimate costs for alternative therapies retrospectively or, using literature reviews, budgetary line items and healthcare insurance costs sheets. This should be avoided from economic evaluations because it mainly reflects on budgetary formulations and has very little in common with the real cost of intervention.
References
Hopley C, Salkeld G, Wang J J, et al. Cost utility of screening and treatment for early age related macular degeneration with zinc and antioxidants. Br J Ophthalmol 2004;88:450–4.
Johns B, Baltussen R, Hutubessy R. Programme costs in the economic evaluation of health interventions. Cost Effectiveness and Resource Allocation 2003;1:1.
Little IMD, Mirrlees JA. Project appraisal and planning for developing countries. London: Heinemann Educational Books, 1974.
Mishan EJ. Cost-benefit analysis. 3rd ed. London: George Allen & Unwin (Publishers) Ltd, 1982.
Adam T, Koopmanschap MA. Cost-effectiveness analysis: can we reduce variability in costing methods? Int J Technol Assess Health Care 2003;19:407–20.
Jefferson T, Demicheli V, Mugford M .Elementaryeconomic evaluation in health care. 2nd ed. London: BMJ Books, 2000.
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997.(Giedrius Vanagas)