Economic evidence contributes to the organization of efficient
health care and to the promotion of the best health outcomes within
budgetary constraints. Despite some inherent limitations, its
importance has increased across the globe amid growing concern over
the rise in the costs of health care. In the United States, this is
coupled with a Federal presence in health policy regulation and
financing, leading to reconsideration of the role of economic and
clinical evidence in decisionmaking by leading actors. In the
United States, the comparative effectiveness of medical
interventions undergoes rigorous evaluation. However, there is
limited use of economic data in comparing health interventions and
creating rational policy in the United States when compared with
best practices in other high-income countries. This is despite
repeated calls for integrating economic evaluation data routinely
into the U.S. health care policy process. The economic evidence
about health care interventions refers to such characteristics as
cost, price elasticity, efficiency, and value data, either
collected empirically or synthesized in economic modeling.19
Economic evaluation combines economic data, such as cost-utility
ratios, net monetary benefit, and total budget impact estimates,
leading to summary economic information on the characteristics of
interventions. Examples are a cost-utility ratio, a
cost-effectiveness ratio, the net monetary benefit, or a total
budget impact estimate. Cost-effectiveness analysis is a specific
type of formalized economic evaluation commonly used in the
consideration of economic evidence in health care. It typically
focuses on the incremental changes in costs and health benefits
after the introduction of a medical intervention as compared to an
initial situation, and is meant to aid rational decisionmaking.
This type of analysis has become the most common mechanism for
generating economic evidence in decisionmaking both inside and
outside the United States. Evidence from systematic reviews of
clinical outcomes presently plays an established role in
determining the comparative effectiveness of medical interventions
and is useful in developing clinical practice guidelines, making
efficacy-based coverage decisions, and in formulating general
health policy. The processes of searching for and summarizing the
results of studies have been standardized with the goal of
demonstrating clinical efficacy and effectiveness in a uniform way,
using all available information. Systematic reviews may also be
valuable in evaluating the economic impact of introducing
interventions. Around the world, standardized guides have been
developed to conduct state-of-the-art economic evaluations, to
include economic data in systematic reviews, to systematically
review economic data, and to use systematic reviews to inform
economic evaluations. In the United States, however, the systematic
inclusion of economic outcomes and the review of economic data in
systematic reviews to inform health policy is not standardized as
is already the case for clinical outcomes.
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