Chapter 8: Fundamentals of cost–utility analysis
In this chapter a general measure of effect is discussed, that is, a QALY. With this more general measure, it is now possible to compare across health care programs. We focus on how CUA widens the sphere of influence of CEA analysis and leave till the next chapter the technical details of how QALYs can be estimated. We compare and contrast CUA with both CEA (in the first section) and CBA (in the third section). In between these comparisons of evaluation methods, we explain how lists of CUA, called ‘league tables’, are, and should be, constructed. We also look at a US panel’s guidelines for making CUA studies comparable. We then outline a comprehensive actual CUA exercise – the Oregon plan – that tried to establish health care priorities in an explicit policy-making setting. The case studies concentrate on how comparisons are made in CUA in order to determine when a cost-per-QALY is worthwhile.
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