Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

Ferrán Catalá-López,Elena Álvarez-Martín,Antoni Parada,Ricard Gènova-Maleras,Consuelo Morant-Ginestar,Anna García-Altés

doi:10.1186/1472-6963-11-75

Abstract

BackgroundThe allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008) and the disease burden in the population.MethodsElectronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS) and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and mortality by cause. Correlation and linear regression models were fitted.ResultsFour hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%), infectious diseases (15.3%), malignant neoplasms (13.2%), and neuropsychiatric diseases (9.6%) were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them). For the main disease categories (n = 20), a correlation was seen with: mortality 0.67 (p = 0.001), DALYs 0.63 (p = 0.003), YLLs 0.54 (p = 0.014), and YLDs 0.51 (p = 0.018). By disease sub-categories (n = 51), the correlations were generally low and non statistically significant.ConclusionsExamining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under-investigated areas. The approach taken could help policy-makers understand whether resources for economic evaluation are being allocated by using summary measures of population health.

Highlights

The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting
The efficiency level could be measured by economic evaluation studies, while the population health needs may be evaluated through health losses attributable to fatal and non-fatal outcomes of the diseases, injuries and associated risk factors, called burden of disease [3,4]
Neumann et al [10] analyzed the relationship between the disease burden and economic evaluations performed in the U.S and other Western countries

Summary

Introduction

The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008) and the disease burden in the population. In recent decades the number of economic evaluations has increased over time [1] for several reasons, including: raised healthcare costs, population aging, epidemiological transition to chronic diseases, as well as continuous development of technological innovation and the explicit need to ensure rational use of existing healthcare resources. The efficiency level could be measured by economic evaluation studies, while the population health needs may be evaluated through health losses attributable to fatal and non-fatal outcomes of the diseases, injuries and associated risk factors, called burden of disease [3,4]. The study by Neumann et al was the first to explore research priorities for a specific type of economic evaluation in healthcare: cost-utility analyses. None of the systematic reviews of the use of economic evaluation published have approached this issue in Southern European countries such as Spain [1,2,11,12]

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Discussion

Conclusion