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      Cuestiones controvertidas en evaluación económica (I): perspectiva y costes de intervenciones sanitarias Translated title: Controversial Issues in Economic Evaluation (I): Perspective and Costs of Health Care Interventions

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          Abstract

          La evaluación económica de intervenciones sanitarias ha experimentado un fuerte desarrollo en la última década y cada vez está más presente como herramienta de apoyo en la toma decisiones sobre financiación pública de prestaciones sanitarias y fijación de precio en Europa. Un elemento necesario para su utilización es que los agentes que realizan las evaluaciones económicas cuenten con unas reglas mínimas de acuerdo sobre aspectos metodológicos. Aunque en algunos de ellos existe un alto grado de consenso, en otros no, por ser más cercanos al ámbito normativo o por haber experimentado avances metodológicos notables en los últimos años. En este primer artículo, de una serie de tres, debatiremos sobre la perspectiva de análisis y la valoración de los costes en evaluación económica de intervenciones sanitarias empleando la técnica Metaplan. Finalmente, se proponen líneas de investigación para tratar de superar las discrepancias identificadas.

          Translated abstract

          Economic evaluation of health care interventions has experienced a strong growth over the past decade and is increasingly present as a support tool in the decisions making process on public funding of health services and pricing in European countries. A necessary element using them is that agents that perform economic evaluations have minimum rules with agreement on methodological aspects. Although there are methodological issues in which there is a high degree of consensus, there are others in which there is no such degree of agreement being closest to the normative field or have experienced significant methodological advances in recent years. In this first article of a series of three, we will discuss on the perspective of analysis and assessment of costs in economic evaluation of health interventions using the technique Metaplan. Finally, research lines are proposed to overcome the identified discrepancies.

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          Most cited references82

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          Economic valuation of informal care. An overview of methods and applications.

          Informal care makes up a significant part of the total amount of care provided to care recipients with chronic and terminal diseases. Still, informal care is often neglected in economic evaluations of health care programs. Probably this is related to the fact that the costs of informal care are to an important extent related to time inputs by relatives and friends of care recipients and time is not easy to value. Development of theoretically sound, yet easily applicable valuation methods is therefore important since ignoring the costs of informal care may lead to undesirable shifts between formal and informal care. Moreover, there is increasing evidence that providing informal care may lead to health problems for the caregiver, both in terms of morbidity and mortality. Until now these health effects have not been incorporated in economic evaluations. More attention for the identification and valuation of the full costs and (health) effects of informal care for the informal caregiver seems needed therefore. This contribution presents a critical evaluation of the available methods to incorporate informal care in economic evaluations.
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            Guide to the methods of technology appraisal

            (2013)
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              Productivity costs in economic evaluations: past, present, future.

              Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                resp
                Revista Española de Salud Pública
                Rev. Esp. Salud Publica
                Ministerio de Sanidad Servicios Sociales e Igualdad (Madrid, Madrid, Spain )
                1135-5727
                2173-9110
                February 2015
                : 89
                : 1
                : 5-14
                Affiliations
                [03] orgnameEscuela Andaluza de Salud Pública
                [01] orgnameUniversidad de Castilla La Mancha
                [02] orgnameOblikue Consulting
                [04] orgnameNovartis
                [05] orgnameUniversitat Pompeu Fabra
                Article
                S1135-57272015000100002
                cffe693d-9350-4d9d-912d-3f4d418bcf43

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 44, Pages: 10
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                SciELO Spain

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                Colaboraciones Especiales

                Economía,Evaluación de resultados,Costes,Costos de la Atención en Salud,Economía y organización de los cuidados de salud,Bioética,Consenso,Economics,Outcome Assessment (Health Care),Health care costs,Health Care Economics and Organizations,Bioethics,Methods,Costs,Consensus

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