Cost–utility analysis (CUA)

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Cost–benefit analysis (CBA)
• Cost-utility analysis (CUA) is a type of economic evaluation used in healthcare
decision-making. It involves comparing the costs and outcomes of different
healthcare interventions to determine which one provides the most value for
money.

• An alternative measurement for the consequences of a health care intervention is

the concept of utility . Utility is a way to measure how much people like a
healthcare treatment based on how it makes them feel. It's like a scale that goes
from 0 (the worst you can feel, like if you were dead) to 1 (the best you can feel,
like if you were super healthy).

• We use this scale to figure out how good a treatment is. We also use something
called quality-adjusted life-year (QALY), which is a way to measure both how
long someone lives and how good their life is while they're alive.
There are a number of methods for the calculation of utilities

1. The Rosser–Kind matrix relies on preferences from population samples from

certain disease groups.
By studying the preferences of these individuals, we can gain insight into
how they prioritize certain treatments and interventions. This information
can help healthcare professionals better understand how to tailor
their treatments to meet the needs and preferences of those in these specific
populations. Ultimately, the Rosser-Kind matrix can help drive more
effective and personalized care for those with certain disease
conditions.
2. The visual analogue scale method seeks to obtain patient preferences for their
perceived disease state by scoring themselves on a line scaled between 0 and 1 as
above.
By providing patients with a line scaled between 0 and 1, they are able to
score themselves based on their personal experience.This method allows
healthcare professionals to gather valuable information from their patients and better
understand how they are impacted by their condition. Ultimately, this information
can be used to tailor treatment plans to better meet the patient's needs and improve
their overall health outcomes.
3. The standard gamble method requires individuals to choose between living the
rest of their lives in their current state of health or making a gamble of an
intervention which will restore them to perfect health. Failure of the gamble will
result in instant death. The probabilities of the gamble are varied until there is
indifference between the two events.

4. The time trade-off method requires individuals to decide how many of their
remaining years of life expectancy they would be prepared to exchange for complete
health.
• Example: Cancer treatment:

Patients with cancer may be asked to consider a hypothetical scenario in which they
could be in perfect health for a shorter period of time, versus remaining in their
current health state for a longer period of time while undergoing chemotherapy or
radiation treatment. By measuring the patient's TTO score, researchers can estimate
the benefit of the treatment in terms of quality-adjusted life years (QALYs).
Cost–benefit analysis (CBA)

• In CBA, consequences are measured in terms of the total cost associated with a
programme where both costs and consequences are measured in monetary terms.
While this type of analysis is preferred by economists, its use in health care is
problematical as it is frequently difficult to ascribe monetary values to clinical
outcomes such as pain relief, avoidance of stroke or improvements in quality of
life.
• Conditional valuation methods can determine cost-benefit for patient groups by
using techniques such as willingness to pay or willingness to accept, which can be
difficult to interpret in socialized healthcare systems funded by general taxation.
These methods involve asking patients how much they would pay to avoid a
symptom or how much they would accept to lose a service.

• CBA can be usefully employed at a macro level for strategic decisions on health
care programmes. For example, a countrywide immunisation programme can be
fully costed in terms of resource utilisation consumed in running the programme.
This can then be valued against the reduced mortality and morbidity that occur as
a result of the programme.
Risk management of unwanted drug effects

• Avoiding the adverse effects of medicines has become a desirable goal of therapeutic decision
makers as well as those who promote quality assurance and risk management. Not only can there
be significant sequelae in terms of increased morbidity associated with adverse drug effects but the
economic consequences can be considerable.
• For example, gentamicin is often regarded as a relatively inexpensive antibiotic but in the USA
each case of nephrotoxicity has been reported to cost several thousands of pounds in terms of
additional resources consumed even without any assessment of the reduction in a patient's quality
of life.