Gezondheidseconomische evaluaties binnen een preventief beleid: een kritische introductie

Abstract

Health-economic evaluations in preventive policy: a critical introduction. The Flemish prevention decree specifies that policy initiatives should maximize health gains at a socially acceptable cost. As health-economic evaluations aim to evaluate the expected health effects as well as the expected costs of interventions, this type of studies can be considered indispensable to come to evidence-based policy. The goal of this paper is to introduce the basic aspects of health-economic evaluations, with a focus on preventive interventions. Although the term cost-effectiveness is often used as an umbrella term, technically speaking there is a distinction between cost-effectiveness studies and cost-utility studies. In the latter case, Belgium and many other countries often use the quality-adjusted life year (QALY) to assess health effects. Health-economic analyses can either be performed alongside a clinical trial, or by the use of a decision-analytic model in which different sources are combined to estimate long-term costs and health effects. How do we handle the effects of prevention in the (sometimes far) future? What is the optimal target group? What about the uncertainty within cost-effectiveness analyses? Can health inequity be incorporated? Several aspects of health-economic evaluations require sufficient attention when analysing preventive policy.