Economic evaluation of health care technologies

Despite two decades of developments, economic evaluation of medical therapies is still in its infancy. The first decade was mainly a search for a relevant methodology, a period when it was important to establish that new medical technologies carried not only costs but also economic benefits. The costs-of-illness methodology was the most convenient to use and served well to show that new medical technology produced economic benefits. It was obvious, however, that the method had its limitations, particularly in health care systems devoting more and more resources to the elderly, not an economically active part of the population. For other people also, health per se is more important than health as a human capital that improves work capacity. The studies undertaken in the 1970s were mainly based on epidemiological data and undertaken at arms' length from clinical activities in hospitals and in general practice. At the beginning of the 1980s, it became clear that in order to become more relevant, economic evaluations have to be linked much more closely to the clinical evaluation of new technologies. Clinicians and economists have to work together to produce good and relevant studies. The beginning of the 1980s saw such an increase in collaboration between economists and clinicians, and some important studies were undertaken. These studies were mainly concerned with calculating costs for different clinical actions and determining cost-effectiveness using, for example, number of life-years gained. During the last 5 years, interest has been focused on the problems and opportunities of including quality of life and utility estimates in economic evaluations.(ABSTRACT TRUNCATED AT 250 WORDS)