Cost-Effectiveness and Cost Utility Analyses: Methods for the Non-Economic Evaluation of Health Care Programmes and How We Can Do Better

Health care procedures are not generally provided and consumed as an end in themselves, but as a means of improving the expected health status of those undergoing the procedures. Health technology assessment aims to provide objective information about the impacts of technologies, including safety, effectiveness, outcomes and costs, as well as social and ethical consequences, in order to assist in making health care decisions and setting health policy. Aging populations, changes in the incidence of diseases and the increasing expectations of populations associated with the rapid developments in medical research have all led to increased pressures on health care systems. In response to these pressures an increasing amount of literature has focussed on the economic evaluation of health care programmes over the lastly twenty five years or so. Studies that have appraised the methods adopted in these evaluations have reported a low1,2 and reducing3,4 rate of compliance with the recommended (and published guidelines for economic evaluations5–11 and have led others to comment on the use and misuse of the evaluation terminology.12