Valeurs seuils pour le rapport coût-efficacité en soins de santé - KCE

KCE reports 100 ICER Thresholds 9
2 ICERS AND ICER THRESHOLD VALUES
2.1 GENERAL PRINCIPLES OF ECONOMIC EVALUATION IN
HEALTH CARE
Economic evaluation is defined as the comparative analysis of alternative courses of
action in terms of both their costs and consequences. 2 In economic evaluation of health
care interventions, ‘consequences’ are most often interpreted as ‘health effects’ or
‘health outcomes’. Both terms will be used interchangeably in this report.
Only evaluations that compare two or more alternatives and consider both costs and
consequences are considered full economic evaluations (see Figure 1). 2
Figure 1: Overview of partial and full economic evaluations
Are both costs (inputs) and consequences (outputs) of alternatives examined?
No
Yes
Outputs only Inputs only
No Outcome description Cost description Cost-outcome description
Cost-utility analysis (CUA),
Efficacy or effectiveness
Yes Cost comparison
evaluation
Cost-benefit analysis (CBA),
Cost-effectiveness analysis (CEA),
Cost-minimisation analysis (CMA)
Comparison of
2 alternatives?
Partial evaluation
Adapted from Drummond et al. (2005) 2
Full economic evaluation
Full economic evaluations are classified according to the way in which the health effects
are expressed. Health effects can be expressed in physical units (cost-effectiveness
analysis, CEA), in terms of utility values (cost-utility analysis, CUA) or in monetary
terms (cost-benefit analysis, CBA). A commonly used outcome measure in CEA is the
‘number of life years gained’ (LYG) by the intervention under study. In CUA, the number
of quality-adjusted life years gained (QALYs) is often used as an outcome parameter,
where LYG are ‘weighted’ for a quantified measure of health-related quality of life
(HRQoL) in those LYG. QALYs are often regarded as just another measure of
effectiveness rather than as a utility measure in its strict utilitarian sense. 6, 7 Therefore
and for the ease of reading, we use the term cost-effectiveness analysis (CEA) for both
cost-per-LYG and cost-per-QALY gained analyses throughout this report. CBA, where
both costs and effects are expressed in monetary terms, is becoming increasingly
unpopular as a technique for health economic evaluations because of the difficulties
experienced in valuing health outcomes in monetary terms. a 3 Therefore, we will
concentrate on CEA in this report. Cost-minimisation analysis is a specific case of CEA
where the health outcomes of the intervention and its comparator are assumed to be
equivalent and where the aim then becomes to obtain those outcomes at the lowest
cost. 2-4
CEA is used to assess efficiency in the production of desirable health outcomes. More
specifically, it aims to help identify how the highest number of LYG or QALYs can be
achieved by allocating limited resources between all possible health interventions. 2-4
a In contrast to CEA or CUA, where one specific measure of health effect is chosen for the evaluation (e.g.
LYG or QALYs), cost-benefit analysis in principle allows the consideration of non-health effects of an
intervention as well. It is therefore a broader form of economic evaluation than CEA or CUA. I.e. if all
effects of an intervention could be expressed in monetary units, there is no reason to restrict the analysis
to health effects only. Consequently, broader comparisons would become possible with CBA, even with
interventions outside the health care sector. An acceptable monetary valuation of all effects remains,
however, difficult.