Utilities and QALYs in health economic evaluations: glossary and introduction

Abstract

Economics studies the optimal allocation of resources for the production of benefits to the society. By definition, resources are limited, and healthcare systems must face this condition every day. This may explain why economic evaluations are increasingly used as a key component of decision making. For instance, they represent a mainstay in any Health Technology Assessment (HTA) exercise and are subject to a guidelines’ development process [1]. After the assessment of the efficacy and safety of health interventions, economic evaluations enter to compare alternative options in terms of costs and consequences. Full economic evaluations consist of a comparison of both costs (resource use) and consequences (outcomes, effects) of alternative strategies [2]. If Cochrane reviews are intended to help providers, practitioners and patients in making informed decisions about health care interventions, they cannot afford to ignore their economic aspects. Cochrane reviews assemble, select, critique and combine reliable data from multiple research studies on the effectiveness and other issues related to healthcare interventions. The latest version of the Cochrane Handbook for Systematic Reviews of Interventions [3], freely accessible at http://www.cochrane-hand book.org, acknowledges that incorporating economic perspectives and evidence into Cochrane reviews can enhance their usefulness and applicability for healthcare decisionmaking. An entire chapter (‘‘Incorporating economics evidence’’), provides guidance on how authors of systematic reviews can collect the best evidence on the economic aspects of interventions in addition to the best evidence on their clinical effectiveness [4]. A leading point here is to expand our knowledge on efficiency (optimal use of resources) after having established effectiveness (whether treatments work) [5]. The main types of full economic evaluations (costeffectiveness, cost-utility and cost-benefit analyses) compare alternative interventions in terms of both costs (resource use) and consequences (effects) and can be included in Cochrane reviews, as well as studies that only focus on costs and resource use, without comparing health alternatives, i.e. partial economic evaluations [4]. Cost-effectiveness analyses measure the effects of an intervention and its comparators in identical units of outcome (e.g. mortality), thus comparing them in terms of ‘cost per unit of effect’ [5]. In a cost-benefit analysis both resource use and effects of alternative interventions are G. Virgili (&) Department of Specialised Surgical Sciences, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy e-mail: gianni.virgili@unifi.it