International Journal of Epidemiology 2002;31:877-878
© International Epidemiological Association 2002
Book Review |
Economic Evaluation in Health Care: Merging theory with practise.
M Drummond, A McGuire (eds). New York: Oxford University Press, 2001, pp. 286, £26.50 (PB). ISBN: 0-19-263176-4; £ 52.50 (HB) ISBN: 0-19-163177-2.
University of Bristol
This book updates and complements the highly successful Methods for Economic Evalutions1 that myriads of health economists affectionately refer to as ‘the blue book’. This book has become a standard textbook of economic evaluation and has proved to be an invaluable tool for everybody working in the field because of its outstanding methodological clarity and didactic qualities. The original work was a landmark publication and set high standards for any future volume.
After reading this new (red covered) book, I predict that people will mention it in the same breath. It is carefully written by internationally acclaimed experts and summarizes recent theoretical and methodological advances of economic evaluation. It also illustrates the rapid scientific development as well as the sub-specialization into single distinctive disciplines within the field. Rather than being an introductory textbook, this edition is aimed at an advanced level; readers with prior knowledge of the subject will appreciate the profound discussions of all-important aspects of economic evaluation in health care.
The book is divided into 11 chapters, building a bridge, as the subtitle of this book suggests, from more theoretical discussions to relevant practical aspects of economic evaluations. Clearly, the first three chapters of this edition fall into the first category. The authors discuss the theoretical underpinnings of these techniques that lie within welfare economics and the suggested alternative ‘extra-welfarisms’. In addition, chapters 2 and 3 illustrate the far-reaching implications on outcome measurement and valuation depending upon which viewpoint an analyst is willing to adopt while carrying out a policy analysis.
Subsequent chapters deal with costing in economic evaluation (chapter 4), take into account the increasing number of economic evaluations conducted alongside clinical trials (chapter 6) and explain the progress being made on dealing with uncertainty in economic evaluations (chapter 8). The ongoing controversy about productivity costs (or indirect costs) is scrutinized and summarized in chapter 5.
Issues on modelling in economic evaluations are superbly dealt with in chapter 7 and it is one of the best condensed resources on this topic I have found in the literature to date. Remaining chapters are devoted to statistical issues in the analysis of health care resource utilization and costs data (chapter 9), discounting (chapter 10) and transferability of economic evaluation results to other settings (chapter 11).
I would have liked to see a chapter about the actual use of economic evaluations to inform resource allocation decisions. Issues that might be addressed in such a chapter could include: ‘Have the results of economic evaluations made a difference in practice, and how?’ and ‘Why are decision makers still reluctant to use these techniques?’ or ‘In which way do they incorporate economic concerns into their decisions?’ Undoubtedly, decision making in health care is a multidisciplinary affair that must incorporate many different values and perspectives from patients, health professionals, health policy makers, the general public etc. Economic evaluation can make this more transparent and provide a normative view as to how these decisions should be made. There is scope for further research to identify possible barriers for the application of economic evaluation results and the best format to present these to relevant decision makers.
As long as methodological issues such as how to measure and value health benefits in economic evaluations (chapter 3) or productivity costs (chapter 5) are unresolved, I doubt whether the strengths of economic analyses in health care are fully appreciated by decision makers. Nevertheless, decision makers need an understanding of the underlying principles and the controversies around them. In illustrating and discussing them, the book clearly succeeds. This is a book to keep and refer to; both health economists and health policy makers will undoubtedly benefit from reading and having this book on their shelf.
Reference
1 Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes, (2nd edn). Oxford, New York: Oxford University Press, 1997.
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