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The analysis of the relationship of pharmaceutical and device costs to
health care systems has been termed pharmacoeconomics, and four types of
analytical techniques are commonly used for this purpose, namely
cost-minimization, cost-benefit, cost-effectiveness, and cost-utility
analyses.1
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With diminishing payments from private and government-based health
insurance programs worldwide, physicians and administrators are forced to
focus attention toward cost-containment in order to maintain a profitable
(or at least “break-even”) enterprise. Cost analysis is an emerging tool
in health care economics, which can help physicians and administrators meet
these new challenges.
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Cost analysis examines health care expenditures, and the subtypes of
cost analysis also examine factors that are inserted into a denominator of a
cost equation. Such factors include monetary benefits (eg, cost-benefit
analysis, or CBA), incremental changes of health-status variables (eg,
cost-effectiveness analysis, or CEA), and patient-reported quality of life
(eg, cost-utility analysis, or CUA).2 If outcomes are
determined to be equivalent regardless of the treatment program implemented,
then a basic cost-minimization analysis is all that is required, since the
denominators are equal and the only relevant comparison is between the cost
numerators of the compared programs.3
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CEA is applicable when the effects of comparable health treatments or
services share the same therapeutic goals, but have different degrees of
effectiveness.4 With CEA, the analyst can compare
alternative treatment strategies so that results can be expressed in
identical effectiveness units. CEA accounts for the effect of a treatment
plan on all clinical outcomes and its economic implications, rather than
considering only the cost of devices, supplies, and
pharmaceuticals.4 Effectiveness indicators, such as the
number of adverse effects avoided or hospital stay reductions, are useful
for comparing the different therapeutic alternatives considered. For this
reason, CEA is one way of comparing treatment plans with the same desired
effect but different outcome profiles, thus producing results expressed in
terms of the number of adverse effects avoided. This approach implies
weighting all adverse effects alike, or weighting the different adverse
effects in the way deemed most suitable by the analyst.4
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With respect to anesthesia selection, it is highly unlikely that
comparing regional (RA) with general anesthesia/volatile agent (GAVA)
techniques would show equal benefits or equal effectiveness (ie, life-years
gained, days of disability avoided). RA significantly differs from GAVA, and
the relevant side effect profiles and risks are quite different as well. In
fact, in the past few years, it has become very clear in ambulatory
procedures, for example, that the choices of the anesthetic and
postoperative analgesic techniques have significant consequences on both the
length of hospital stay and the frequency of unplanned
hospitalization,5,6 and consequently, the overall cost of
the surgery. As a result, comparisons between RA and GAVA would require ...