European Spine Journal

, 15:S109

Economic evaluations: a new avenue of outcome assessment in spinal disorders

  • Nicole van der Roer
  • Norbert Boos
  • Maurits W. van Tulder
Review

Abstract

The number of economic evaluations in the field of spinal disorders and methodological studies have increased in the last decade. The objective of this paper is to provide an overview of current views on economic evaluations in the field of spinal disorders and to facilitate clinicians to interpret and use results from these studies. A full economic evaluation compares both costs and effects of two or more interventions. Key elements of economic evaluations such as identifying adequate alternatives, analytical perspective, cost methodology, missing values and sensitivity analyses are addressed. Further emphasis is placed on the interpretation of results of economic evaluations conducted alongside randomised clinical trials. Incremental cost–effectiveness ratios, cost–effectiveness planes, acceptability curves and cost–effectiveness thresholds are discussed. The contents may aid in taking the efficacy ‘hurdle’ in the field of spinal disorders.

Keywords

Economic evaluations Spinal disorders Methodology Assessment 

References

  1. 1.
    (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: cost effectiveness of physical treatments for back pain in primary care. BMJ 329:1381Google Scholar
  2. 2.
    Barber JA, Thompson SG (1998) Analysis and interpretation of cost data in randomised controlled trials: review of published studies. BMJ 317:1195–1200PubMedGoogle Scholar
  3. 3.
    Barber JA, Thompson SG (2000) Analysis of cost data in randomized trials: an application of the non-parametric bootstrap. Stat Med 19:3219–3236PubMedCrossRefGoogle Scholar
  4. 4.
    Birch S, Gafni A (1993) Changing the problem to fit the solution: Johannesson and Weinstein’s (mis) application of economics to real world problems. J Health Econ 12:469–476PubMedCrossRefGoogle Scholar
  5. 5.
    Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine 25:3100–3103PubMedCrossRefGoogle Scholar
  6. 6.
    Briggs A, Fenn P (1998) Confidence intervals or surfaces? Uncertainty on the cost–effectiveness plane. Health Econ 7:723–740PubMedCrossRefGoogle Scholar
  7. 7.
    Briggs AH, Gray AM (1999) Handling uncertainty in economic evaluations of healthcare interventions. BMJ 319:635–638PubMedGoogle Scholar
  8. 8.
    Briggs AH, O’Brien BJ (2001) The death of cost–minimization analysis? Health Econ 10:179–184PubMedCrossRefGoogle Scholar
  9. 9.
    Briggs AH, O’Brien BJ, Blackhouse G (2002) Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost–effectiveness studies. Annu Rev Public Health 23:377–401PubMedCrossRefGoogle Scholar
  10. 10.
    Briggs A, Clark T, Wolstenholme J, Clarke P (2003) Missing presumed at random: cost-analysis of incomplete data. Health Econ 12:377–392PubMedCrossRefGoogle Scholar
  11. 11.
    Coyle D (1996) Statistical analysis in pharmacoeconomic studies. A review of current issues and standards. Pharmacoeconomics 9:506–516PubMedCrossRefGoogle Scholar
  12. 12.
    Desgagne A, Castilloux AM, Angers JF, LeLorier J (1998) The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics 13:487–497PubMedCrossRefGoogle Scholar
  13. 13.
    Devlin N, Parkin D (2004) Does NICE have a cost–effectiveness threshold and what other factors influence its decisions? A binary choice analysis. Health Econ 13:437–452PubMedCrossRefGoogle Scholar
  14. 14.
    Drummond MF, Jefferson TO (1996) Guidelines for authors and peer reviewers of economic submissions to the BMJ The BMJ Economic Evaluation Working Party. BMJ 313:275–283PubMedGoogle Scholar
  15. 15.
    Drummond MF, O’Brien B, Stoddart GL, Torrance GW (1997) Methods for the economic evaluation of health care programmes, 2nd edn. Oxford University Press, OxfordGoogle Scholar
  16. 16.
    Eichler HG, Kong SX, Gerth WC, Mavros P, Jonsson B (2004) Use of cost–effectiveness analysis in health-care resource allocation decision-making: how are cost–effectiveness thresholds expected to emerge? Value Health 7:518–528PubMedCrossRefGoogle Scholar
  17. 17.
    Evers S, Goossens M, de Vet HC, van Tulder M, Ament A (2005) Assessment of methodological quality of economic evaluations-CHEC. Int J Technol Assess Health CareGoogle Scholar
  18. 18.
    Fenwick E, O’Brien BJ, Briggs A (2004) Cost–effectiveness acceptability curves—facts, fallacies and frequently asked questions. Health Econ 13:405–415PubMedCrossRefGoogle Scholar
  19. 19.
    Fritzell P, Hagg O, Jonsson D, Nordwall A (2004) Cost–effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine 29:421–434PubMedCrossRefGoogle Scholar
  20. 20.
    Gafni A, Birch S (1993) Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem. CMAJ 148:913–917PubMedGoogle Scholar
  21. 21.
    Gold MR, Siegel JE, Russel LB, Weinstein MC (1996) Cost–effectiveness in health and medicine. Oxford University Press, New YorkGoogle Scholar
  22. 22.
    Goossens ME, Rutten-van Molken MP, Vlaeyen JW, van der Linden SM (2000) The cost diary: a method to measure direct and indirect costs in cost–effectiveness research. J Clin Epidemiol 53:688–695PubMedCrossRefGoogle Scholar
  23. 23.
    Gravelle H, Smith D (2001) Discounting for health effects in cost–benefit and cost–effectiveness analysis. Health Econ 10:587–599PubMedCrossRefGoogle Scholar
  24. 24.
    Graves N, Walker D, Raine R, Hutchings A, Roberts JA (2002) Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods. Health Econ 11:735–739PubMedCrossRefGoogle Scholar
  25. 25.
    Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG (2000) Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making 20:332–342PubMedCrossRefGoogle Scholar
  26. 26.
    Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L (1995) The friction cost method for measuring indirect costs of disease. J Health Econ 14:171–189PubMedCrossRefGoogle Scholar
  27. 27.
    Korthals-de Bos IB, Hoving JL, Van Tulder MW, Rutten-van Molken MP, Ader HJ, de Vet HC, et al. (2003) Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. BMJ 326:911PubMedCrossRefGoogle Scholar
  28. 28.
    Kovacs FM, Llobera J, Abraira V, Lazaro P, Pozo F, Kleinbaum D (2002) Effectiveness and cost–effectiveness analysis of neuroreflexotherapy for subacute and chronic low back pain in routine general practice: a cluster randomized, controlled trial. Spine 27:1149–1159PubMedCrossRefGoogle Scholar
  29. 29.
    Nixon RM, Thompson SG (2004) Parametric modelling of cost data in medical studies. Stat Med 23:1311–1331PubMedCrossRefGoogle Scholar
  30. 30.
    O’Brien BJ, Briggs AH (2002) Analysis of uncertainty in health care cost–effectiveness studies: an introduction to statistical issues and methods. Stat Methods Med Res 11:455–468PubMedCrossRefGoogle Scholar
  31. 31.
    O’Hagan A, Stevens JW (2003) Assessing and comparing costs: how robust are the bootstrap and methods based on asymptotic normality? Health Econ 12:33–49PubMedCrossRefGoogle Scholar
  32. 32.
    Oostenbrink JB, Al MJ (2005) The analysis of incomplete cost data due to dropout. Health EconGoogle Scholar
  33. 33.
    Oostenbrink JB, Koopmanschap MA, Rutten FF (2002) Standardisation of costs: the Dutch Manual for Costing in economic evaluations. Pharmacoeconomics 20:443–454PubMedCrossRefGoogle Scholar
  34. 34.
    Oostenbrink JB, Al MJ, Rutten-van Molken MP (2003) Methods to analyse cost data of patients who withdraw in a clinical trial setting. Pharmacoeconomics 21:1103–1112PubMedCrossRefGoogle Scholar
  35. 35.
    Palmer S, Byford S, Raftery J (1999) Economics notes: types of economic evaluation. BMJ 318:1349PubMedGoogle Scholar
  36. 36.
    Polsky D, Glick HA, Willke R, Schulman K (1997) Confidence intervals for cost–effectiveness ratios: a comparison of four methods. Health Econ 6:243–252PubMedCrossRefGoogle Scholar
  37. 37.
    Robinson R (1993) Cost–effectiveness analysis. BMJ 307:793–795PubMedCrossRefGoogle Scholar
  38. 38.
    van der Roer N, Goossens M, Evers S, van Tulder M (2005) What is the most cost-effective treatment for patients with low back pain? A systematic review. Best Pract Res Clin RheumatolGoogle Scholar
  39. 39.
    Seferlis T, Lindholm L, Nemeth G (2000) Cost-minimisation analysis of three conservative treatment programmes in 180 patients sick-listed for acute low-back pain. Scand J Prim Health Care 18:53–57PubMedCrossRefGoogle Scholar
  40. 40.
    Sendi PP, Briggs AH (2001) Affordability and cost–effectiveness: decision-making on the cost–effectiveness plane. Health Econ 10:675–680PubMedCrossRefGoogle Scholar
  41. 41.
    Siegel JE, Weinstein MC, Russell LB, Gold MR (1996) Recommendations for reporting cost–effectiveness analyses. Panel on cost–effectiveness in health and medicine. JAMA 276:1339–1341PubMedCrossRefGoogle Scholar
  42. 42.
    Siegel JE, Torrance GW, Russell LB, Luce BR, Weinstein MC, Gold MR (1997) Guidelines for pharmacoeconomic studies. Recommendations from the panel on cost effectiveness in health and medicine. Panel on cost effectiveness in health and medicine. Pharmacoeconomics 11:159–168PubMedCrossRefGoogle Scholar
  43. 43.
    Stinnett AA, Mullahy J (1998) Net health benefits: a new framework for the analysis of uncertainty in cost–effectiveness analysis. Med Decis Making 18:S68–S80PubMedCrossRefGoogle Scholar
  44. 44.
    Taylor RS, Drummond MF, Salkeld G, Sullivan SD (2004) Inclusion of cost effectiveness in licensing requirements of new drugs: the fourth hurdle. BMJ 329:972–975PubMedCrossRefGoogle Scholar
  45. 45.
    Thompson S (2002) Statistical issues in cost–effectiveness analyses. Stat Methods Med Res 11:453–454PubMedCrossRefGoogle Scholar
  46. 46.
    Thompson SG, Barber JA (2000) How should cost data in pragmatic randomised trials be analysed? BMJ 320:1197–1200PubMedCrossRefGoogle Scholar
  47. 47.
    Van Hout BA, Al MJ, Gordon GS, Rutten FF (1994) Costs, effects and C/E-ratios alongside a clinical trial. Health Econ 3:309–319PubMedCrossRefGoogle Scholar
  48. 48.
    Van Tulder MW, Koes BW, Bouter LM (1995) A cost-of-illness study of back pain in The Netherlands. Pain 62:233–240PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Nicole van der Roer
    • 1
  • Norbert Boos
    • 2
  • Maurits W. van Tulder
    • 3
  1. 1.VU Medical CentreInstitute for Research in Extramural MedicineAmsterdamThe Netherlands
  2. 2.Center for Spinal SurgeryUniversity of ZurichZurichSwitzerland
  3. 3.Faculty of Earth and Life SciencesVU Medical Centre, Institute for Health SciencesAmsterdamThe Netherlands

Personalised recommendations