Methods for the Economic Evaluation of Health Care Programmes

461 Pages·2015·6.49 MB·English

by  Michael F. Drummond

Methods for the Economic
Evaluation of Health Care
Programmes

Methods for
the Economic
Evaluation of Health
Care Programmes
FOURTH EDITION
Michael F. Drummond
Professor, Centre for Health Economics,
University of York, UK
Mark J. Sculpher
Professor, Centre for Health Economics,
University of York, UK
Karl Claxton
Professor, Department of Economics and Related Studies and
Centre for Health Economics, University of York, UK
Greg L. Stoddart
Professor Emeritus, McMaster University, Hamilton, Canada
George W. Torrance
Professor Emeritus, McMaster University, Hamilton, Canada
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1
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Second edition published in 1997
Third edition published in 2005
Fourth edition published in 2015
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In memory of our friend and colleague, Bernie O’Brien

Preface to the fourth edition
The first question in anyone’s mind reading the fourth edition of any book will be ‘What
has changed from previous editions?’ The most obvious change, in keeping with the
tradition we have maintained since the outset, is the addition of a new coauthor, Karl
Claxton. Like all those before him, Karl has questioned aspects of the work and pro-
voked changes which otherwise may not have been made.
The other change, of course, is that the field itself has moved on in the 10 years since
the last edition. The new edition reflects these changes. Chapters 5 and 6, on measuring
and valuing effects, reflect the growth in the literature on the measurement of health
gain and other benefits of health care. In addition, we include two new chapters (10 and
11) discussing the methods of evidence synthesis and characterizing uncertainty, given
their growing importance in economic evaluation.
However, considering the 28-year period since the original publication of the book,
the most fundamental change relates to the role of economic evaluation in health care
decision-making. Back in 1987 our emphasis was on explaining the methods used in
economic evaluations so that readers could critically appraise them and potentially
embark on their own studies. As the role of economic evaluation in decision-making
expanded we added a chapter on ‘Presentation and use of economic evaluation results’,
discussing the use of cost-effectiveness thresholds and the transferability of data from
one setting to another. However, in discussing the content of the fourth edition, we
realised that this was no longer sufficient because, owing to the international growth in
the use of economic evaluation, it has become apparent that the use of particular meth-
ods is best discussed in the context of the decision problem being faced.
Therefore, in this edition we have added two new chapters (2 and 4) which emphasize
that, in health care decision-making, it is important to be clear on what we are trying to
maximize (for example, health or welfare), the constraints that we face, and the import-
ance of opportunity cost. This enables us to give additional insights on the role of the
various analytic approaches, given the decision-making context. In essence, the choice
of methods and the use of study results are now integrated throughout the book, rather
than being discussed in separate chapters.
We hope that readers feel that the new edition represents an improvement on previ-
ous editions and that it leads to further advances in both methods and decision-making
processes in the future.
Michael F. Drummond Mark J. Sculpher
Karl Claxton George W. Torrance
Greg L. Stoddart
York, UK and Hamilton, Canada
Acknowledgements
We would like to thank a number of people who have helped us in important ways
in developing the 4th edition of this book. The following individuals provided com-
ments and suggestions on draft chapters which greatly improved the book: Bernard
van den Berg, John Brazier, Tony Culyer, Catherine Claudius Cole, Richard Grieve,
Jonathan Karnon, Andrew Lloyd, Andrea Manca, Gavin Roberts, Marta Soares and
Beth Woods. Needless to say, none of the above are responsible for the final views
expressed. Rita Faria and Sebastian Hinde helped develop the critical appraisal exer-
cises for Chapter 3. Gill Forder, Frances Sharp, and Gillian Robinson provided a range
of assistance in formatting and checking materials. We are grateful to all.
Contents
List of abbreviations xii
1 Introduction to economic evaluation 1
1.1 Some basics 1
1.2 Why is economic evaluation important? 2
1.3 The features of economic evaluation 3
1.4 Do all economic evaluations use the same techniques? 5
1.5 Use of economic evaluation in health care decision-making 11
1.6 How to use this book 13
2 Making decisions in health care 19
2.1 Some basics 19
2.2 Informing health care choices 19
2.3 Requirements for economic evaluation 22
2.4 What is the purpose of health care interventions? 27
2.5 Concluding remarks 37
3 Critical assessment of economic evaluation 41
3.1 Some basics 41
3.2 Elements of a sound economic evaluation 41
3.3 Reporting guidelines for economic evaluation 61
3.4 Limitations of economic evaluation techniques 63
3.5 Conclusions 64
3.6 Critical appraisal of published articles 65
4 Principles of economic evaluation 77
4.1 Alternatives, costs, and benefits: some basics 77
4.2 Making decisions about health care 79
4.3 The cost-effectiveness threshold 83
4.4 Making decisions with multiple alternatives 98
4.5 Some methodological implications 106
4.6 Concluding remarks 116
5 Measuring and valuing effects: health gain 123
5.1 Some basics 123
5.2 Using health effects in economic evaluation 124
5.3 Measuring preferences for health states 133