Economic evaluation

This section contains the following:


Resources available to health care decision-makers are scarce.  When choosing which intervention to adopt,  decision makers have to trade off the benefits against the costs. As a result, decision-makers and funding bodies now increasingly require information not only on the effectiveness of the particular intervention but also on its efficiency relative to other interventions.  This has led to the inclusion of concurrent economic evaluations as standard practice alongside trials of the effectiveness of interventions.
An ECONOMIC EVALUATION is “the comparative analysis of alternatives courses of action in terms of both their costs and consequences”. There are different types of economic evaluations:

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Things to consider when writing a protocol

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Additional resources

Trial Protocol Tool resource iconEconomic Evaluations alongside Randomised Controlled Trials.

This workbook was contributed by Rodolfo Hernandez, Health Economics Research Unit, University of Aberdeen

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Trial Protocol Tool resource iconWHO Economic Evaluations Workbook

This workbook is about economic evaluation. Economic evaluations involve the identification, measurement and valuation, and then comparison of the costs (inputs) and benefits (outcomes) of two or more alternative treatments or activities.

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Web resource iconHealth Utilities Group / Health Utilities Index And Quality-Of-Life

The Health Utilities Index (HUIR) is a generic, preference-scored, comprehensive system for measuring health status, health-related quality of life, and producing utility scores. The Health Utilities Group (HUG) focuses on preference-based measures of health-related quality of life for describing treatment process and outcomes in clinical studies, for population health studies, and economic evaluations of health care services.

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Web resource iconEQ-5D

EQ-5D is a standardised instrument for use as a measure of health outcome. Applicable to a wide range of health conditions and treatments, it provides a simple descriptive profile and a single index value for health status that can be used in the clinical and economic evaluation of health care.

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Web resource iconCentre for Health Evidence

How to use an Article on Economic Analysis of Clinical Practice. Bernie J. O'Brien, Ph.D., Daren Heyland, M.D., W. Scott Richardson, M.D., Mitchell Levine, M.D., Michael F. Drummond, Ph.D., for the Evidence-Based Medicine Working Group. Based on the Users Guides to Evidence-based Medicine and reproduced with permission from JAMA. (1997 May 21; 277(19):1552-1557) and (1997 Jun 11; 277(22):1802-1806) (Published erratum in 1997 Oct 1; 278(13):1064). Copyright 1999, American Medical Association.

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Web resource iconNHS Economic Evaluation Database (NHS EED)

NHS Economic Evaluation Database (NHS EED). National Health Service Centre for Reviews and Dissemination (NHS CRD). University of York. UK.

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Further reading

Glick, H.A., Polsky, D.P., and Shulman, K.A.: “Trial-based economic evaluations: an overview of design and analysis” in Drummond M and McGuire. Economic Evaluation in Health Care: merging theory with practice. Office for Health Economics. Oxford University Press. 2001 Briggs A, Gray A: “Using cost effectiveness information”. BMJ 2000;320:246. (  

Drummond M: “Economic analysis alongside controlled trials: an introduction for clinical researchers”. Department of Health, UK. 1994.

Coyle D, Davies L, Drummond MF. Trial and tribulations. Emerging Issues in Designing Economic Evaluation Alongside Clinical Trials. International Journal of Technology Assessment in Health Care 1998;14:135-144.

Donaldson C.  Hundley V.  McIntosh E. Using economics alongside clinical trials: why we cannot choose the evaluation technique in advance. Health Economics.  5(3):267-9, 1996 May-Jun

Drummond M.  O’Brien B. Economic analysis alongside clinical trials: Practical considerations. Journal of Rheumatology. Vol 22(7) (pp 1418-1419), 1995

Drummond M. Economic analysis alongside clinical trials: Problems and potential. Journal of Rheumatology. Vol 22(7) (pp 1403-1407), 1995

Drummond M, Davies L. Economic analysis alongside clinical trials. Revisiting the methodological issues. International Journal of Technology Assessment in Health Care 1991;7:561-573

Gray, A.M., and Marshall, A., et al.  Problems of conducting economic evaluation alongside clinical trials. Lessons from a study of case management for people with mental disorders. British Journal of Psychiatry 1997;170 47-52

Jain S. Arora NK. Randomized controlled trial and economic evaluation. Indian Journal of Pediatrics.  67(5):363-8, 2000 May.

Briggs AH, Gray AM: “Handling uncertainty when performing economic evaluation of health care interventions”. Health Technology Assessment 1999; vol.3: No2. (

Cairns J.: ”Discounting in economic evaluation” in Drummond M and McGuire. Economic Evaluation in Health Care: merging theory with practice. Office for Health Economics. Oxford University Press. 2001

Mitchell, R. C and Carson, R. T. Using surveys to value public goods: the contingent valuation method. Washington DC. Resources for the Future. 1998.

Johnston K, Buxton MJ, Jones DR, Fitzpatrick R: “Assessing the cost of healthcare technologies in clinical trials”. Health Technology Assessment 1999 vol. 3: No.6 (

Economics notes: Economic evaluation: an introduction James Raftery BMJ 1998; 316: 1013-1014.

Economics notes: Perspectives in economic evaluation Sarah Byford and James Raftery BMJ 1998; 316: 1529-1530.

Economics Notes: Types of economic evaluation Stephen Palmer, Sarah Byford, and James Raftery BMJ 1999; 318: 1349.

Economics notes: Opportunity cost Stephen Palmer and James Raftery BMJ 1999; 318: 1551-1552.

Economic Note: Cost of illness studies Sarah Byford, David J Torgerson, and James Raftery BMJ 2000; 320: 1335.

Economics notes: Costing in economic evaluation James Raftery BMJ 2000; 320: 1597.

Economics Notes: Measuring outcomes in economic evaluations David Torgerson and James Raftery BMJ 1999; 318: 1413.

Economics notes: Discounting David J Torgerson and James Raftery BMJ 1999; 319: 914-915.
Guidelines for authors and peer reviewers of economic submissions to the BMJ M F Drummond and T O Jefferson BMJ 1996; 313: 275-283.

New BMJ policy on economic evaluations  Dawn Craig, John Nixon, Nigel Armstrong, Julie Glanville, Jos Kleijnen, Michael Drummond, Tracy Roberts, Alastair M Gray, Andrew Briggs, Philip Clarke, Charles Normand, Christopher J McCabe, Jennifer Roberts, and Richard Smith BMJ 2003; 326: 445. ( )

Christopher J.L. Murray, David B. Evans, Arnab Acharya, Rob M.P.M. Baltussen. Development of WHO Guidelines on Generalised Cost-Effectiveness Analysis.

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This page was last updated 4th June 2004.