Economic Analysis in Practice

Will the results help in caring for my patients?

Can my patients expect similar health outcomes?

Can I expect similar costs / level of resource consumption?

As with all aspects of Evidence Based Medicine, there comes a point when one must try to abstract the results of a research paper to one’s own practice. The questions which a physician must ask are: are my patients similar? Are my costs similar. For example, a CEA performed on drugs used for sedation may recommend the use of the less expensive agent, which may be marginally less effective than the other. If, however, in another country, the cost of the drugs was not dissimilar, then the conclusions of the study would be void. The pharmaceutical industry acts as an oligopoly and tend to price drugs in individual countries in relation to local price elasticity. Consequently, there is often enormous differences in prices between countries.

Moreover, one must take into account local resources – provincial hospitals in India would be more likely to use healthcare funds on treating Tuberculosis or diarrheal illness than on cardiac surgery, even if it has been shown to be cost effective in the United States.  Many local costs may be dissimilar to those in the country of origin, in particular the cost of labour.

The indivisibility and intangibility of outcomes are a concern. If there are only 6 patients requiring chronic dialysis in a region, and CEAs determine that the optimal number is 8 to provide a local service, this does not take into account the opportunity cost and the inconvenience factor of travelling to a larger center. Sometimes, as in rural bus services, cost effectiveness is not an issue. Healthcare cannot be seen as all or nothing, and often compromise is necessary. Remember, society is often willing to pay the cost even if effectiveness is not yet established.

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