The Cost of Critical Care Economic Analysis

      
       

 

          
       

Most worthwhile economic evaluations in the critical care literature feature CEAs or CUAs. A structured paradigm along evidence based lines is necessary for appraisal of these studies. Chalfin [1998] describes eight steps in analysing a cost effectiveness study:

  1. Explicit descriptions of the problem under investigation and all possible   alternatives

  2. Explicit description of the study's perspective

  3. Determination of all costs

  4. Determination of all benefits

  5. Discounting

  6. Determination of the cost-effectiveness ratio

  7. Sensitivity analysis

  8. Recognition of limitations

The Evidence Based Medicine in Critical Care Group have adapted this method and added classic critical appraisal questions. The following comes from Heyland and Cook (1999):

I.           Are the results valid?
1) Did the analysis provide a full comparison of effective healthcare strategies?
2) Were the costs and outcomes adequately identified, measured and valued?
3) Was an appropriate allowance made for uncertainties in the analysis?

II.         What were the results?
1) What were the incremental costs and effects of each strategy?
2) Do incremental costs and effects differ between subgroups?

III.         Will the results help in caring for my patients?
1) Can my patients expect similar health outcomes?
2) Can I expect similar costs, or at least, similar levels of resource consumption?
3) Are the treatment benefits worth the harms and costs?

Both systems ask the same questions, but Chalfin’s second point is worth looking at: what exactly is the perspective of the study, that is – who exactly is represented by the study?  An intervention which may be cost effective for one segment of society may be not so for another (e.g. cancer screening – the risk may vary from one group to another). It is conventional for CEAs to take a societal perspective, that is, the costs and benefits accrue to society as a whole.

          
                   
       

         
     

       
       

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