Health professionals’ aim is to provide patients with the best possible care. Unfortunately, in doing this, they face financial and economic difficulties: the demand for health care - because of past successes and because of the emergence of effective new technologies - has often exceeded the available financial and human resources.
As a result, health care interventions have been evaluated not only for their quality, safety and effectiveness, but also for their costs, with the aim of investigating their efficiency. Economic evaluations put into relation costs and consequences of health care programmes and calculate indices of efficiency.
There are three main techniques used in full economic evaluations of health care programmes: cost effectiveness analysis (CEA), cost utility analysis (CUA) and cost benefit analysis (CBA). All techniques address the issue: ‘‘which is the cost to reach a unit of effect?’’. The main difference among the techniques is the unit of measurement used to quantify the effects. In a CEA, effects are expressed in natural units, such as death avoided or life year gained: a cost per life year gained is a common result of a CEA. In a CUA the effect of health care are usually measured in terms of quality adjusted life years (QALY’s), a single index which incorporates information on both quantity and quality of life. A cost per QALY gained is a common result of a CUA. In a CBA, also effects are turned into monetary values, using appropriate, complex methods. A cost to benefit ratio or a net cost are common results of a CBA.
The applicability and the appropriateness of these techniques in the field of palliative care will be discussed, with special focus on the trade off between quantity and quality of life in CUA’s and on the measurement of patients’ preferences in CBA’s.