STEPS IN AN ECONOMIC EVALUATION
Economic evaluations serve as a formal approach for comparing competing interventions from which to make decisions concerning the allocation of scarce resources. For example, when a new technology or intervention has been developed, a government or health plan must decide if it is willing to reimburse or pay for it. An economic evaluation provides important information by which to make a decision regarding reimbursement. There are six basic steps for completing a health economic evaluation of a behavioral intervention as shown in Figure 18.1.
Step 1: Determine the Primary Adopter of the Intervention
The first step in conducting an economic evaluation is to decide who is the primary adopter of the intervention. The adopter is the stakeholder (individual, organization, or collective group of organizations) that holds the primary responsibility for deciding whether to implement the treatment and whose perspective is used to evaluate costs. Typically, the adopter bears financial responsibility for the management of health care. There are different perspectives that can be assumed.
Figure 18.1 Steps to conduct economic evaluations of behavioral interventions.
Perspectives that are commonly chosen for economic evaluations include health care payer (including public payers such as Medicare and Medicaid, as well as private payers such as employers or employer coalitions), health care plan, health care delivery system, individual provider (e.g., physician or other health care provider), participant (or participant-family unit), health sector, or society as a whole (referred to as “societal perspective”). The health sector perspective includes health care costs paid by health plans but also participants’ out-of-pocket costs. The societal perspective encompasses all costs and benefits to society. The Panel on Cost-Effectiveness in Health and Medicine recommends the societal perspective as a primary perspective for an analysis (Gold, Siegel, Russell, & Weinstein, 1996). Although the societal perspective is the gold standard (Gold et al., 1996) in the United States, many studies have also adopted health care plan, health care payer, or health care delivery system perspectives. In contrast, countries with national health care systems such as the United Kingdom, Australia, and Canada tend to apply broader perspectives (e.g., health sector or societal perspective) to economic evaluations. Defining the perspective early on in the analytic process is important as it frames the subsequent steps in conducting the economic evaluation. As the perspective broadens (i.e., from individual/participant to societal), more costs and benefits will need to be captured or collected and then included in the analysis.