1987). In addition, it avoids CBA problem of measuring health in monetary terms (Johannesson and Jonsson, 1991). CEA has received the favour of extra-welfarists because, differently from CBA, it focuses entirely on the maximization of health (benefits are measured as changes in health), excluding other components of utility from the analysis. However, the technique does not allow comparing treatment/programs/interventions across disease areas and disease groups (being focused on the natural unit of measurement only interventions with the same outcome can be compared) (Drummond et al, 2005), nor to compare interventions that differ in more than one treatment outcome (e.g. Brazier et al, 2007). For these reasons, CEA can be used only if the objective is to increase the level of effectiveness while maintaining a given budget, or maintaining the same level of effectiveness while reducing the budget (Morris et al, 2007). Cost-utility analysis CUA is a form of CEA that instead of comparing costs with the natural unit of the program compares them using a synthetic index of the length and HRQoL of individuals, with the later being based on utility. This is usually expressed in terms of QALYs and is easily obtained by multiplying the length of time passed in the condition by a value calculated on a scale from 0 to 1 (Drummond et al, 2005). This value is meant to reflect the strength of preference of individuals over different health states (utility). CUA shares with CEA the idea that there is no additional objective to health care than health maximization (Mooney, 2003) and in that it is favourably looked at by extra-welfarists. In addition, this seems the most reasonable approach in a number of health systems, such as the UK one, where the majority of individuals support public institutions expecting them to maximize health under the national budget (Garrison Jr., 2009). In fact, CUA employs a perspective where social welfare is externally assessed by the community, and uses values of an intervention derived from a representative sample of the general population (Brazier et al, 2017). Measurement and valuation of health for incorporation in QALYs are discussed in the next section.
1987). In addition, it avoids CBA problem of measuring health in monetary terms (Johannesson and Jonsson, 1991). CEA has received the favour of extra-welfarists because, differently from CBA, it focuses entirely on the maximization of health (benefits are measured as changes in health), excluding other components of utility from the analysis. However, the technique does not allow comparing treatment/programs/interventions across disease areas and disease groups (being focused on the natural unit of measurement only interventions with the same outcome can be compared) (Drummond et al, 2005), nor to compare interventions that differ in more than one treatment outcome (e.g. Brazier et al, 2007). For these reasons, CEA can be used only if the objective is to increase the level of effectiveness while maintaining a given budget, or maintaining the same level of effectiveness while reducing the budget (Morris et al, 2007). Cost-utility analysis CUA is a form of CEA that instead of comparing costs with the natural unit of the program compares them using a synthetic index of the length and HRQoL of individuals, with the later being based on utility. This is usually expressed in terms of QALYs and is easily obtained by multiplying the length of time passed in the condition by a value calculated on a scale from 0 to 1 (Drummond et al, 2005). This value is meant to reflect the strength of preference of individuals over different health states (utility). CUA shares with CEA the idea that there is no additional objective to health care than health maximization (Mooney, 2003) and in that it is favourably looked at by extra-welfarists. In addition, this seems the most reasonable approach in a number of health systems, such as the UK one, where the majority of individuals support public institutions expecting them to maximize health under the national budget (Garrison Jr., 2009). In fact, CUA employs a perspective where social welfare is externally assessed by the community, and uses values of an intervention derived from a representative sample of the general population (Brazier et al, 2017). Measurement and valuation of health for incorporation in QALYs are discussed in the next section.
PhD%20thesis%20FINAL_after%20VIVA_SUBMITED.docx