Economic evaluation of nuclear medicine procedures

Abstract

Healthcare regulators anxious to contain spiralling healthcare costs have started to look hard at the area of medical imaging, alarmed by its rapid expansion. However, although it may be tempting to spend less on medical imaging in an attempt to cut costs, in many settings increasing medical imaging would actually reduce healthcare costs, and also improve patient outcomes [1]. So-called health economic evaluations are studies that consider the costs and outcomes of given diagnostic procedures and interventions, aiming to optimise the allocation of health service resources and thereby maximise the level of health in the population of interest. There are three main types of evaluation: cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and cost-benefit analysis (CBA) [2]. The CEA takes a common effectiveness measure (e.g. cost per accurately diagnosed patient or per life year gained) and uses it to compare alternative interventions, also taking into account their relative costs. The incremental cost-effectiveness ratio (ICER) is a parameter calculated in order to effect these comparisons, whose results may, for example, be stated in terms of costs per life year gained. The ICER highlights the additional costs generated by the implementation of a new diagnostic test or intervention and relates them to the health outcome: ICER=(costsnew test— costsstandard test)/( life years gainednew test—life years gainedstandard test). Acceptable ICER thresholds (maximum ICERs)—i.e., the levels at which the funding of health interventions is deemed justified on the basis of the benefit to the population—differ between countries according to wealth and societal preferences. For instance, the UK National Institute for Health and Clinical Excellence (NICE) defines a threshold of £30,000 per additional life year gained as acceptable. The advantages of the CEA are its simplicity and its costs, which are usually lower than those incurred by the CUA and the CBA. In fact, whereas CEAs usually measure effectiveness in daily, routine care or in clinical trials, in CUAs and CBAs patients have to be specially interviewed [2]. Cost-effectiveness analyses usually measure health outcome in terms of life years gained, but in some cases it is necessary to consider not only the “quantity” of life gained but also the “quality” of life (as in the case of palliative care, for example). In such cases, the unit of measure normally used is defined “quality-adjusted life year” (QALY) and the CUA “Focus on...” abridgements aim to highlight papers published within the past year and draw extensively on the texts and summaries of the articles referenced. Less recent citations are also included when deemed useful to provide background information on the topic reviewed.