The complex interface between economy and healthcare: An introductory overview for clinicians

Published:August 28, 2016DOI:


      • Efficiency means maximizing the benefit from a pre-determined budget.
      • Cost-effectiveness and cost-utility analysis are the principal methods.
      • QALYs allow to compare treatments in different health sectors.
      • Patients' needs and preferences should be integrated within the healthcare budget.
      • Implementation of economic evaluation in health care should increase social equity.


      In a period of generalized economic crisis, it seems particularly appropriate to try to manage a continuing growing sector such as healthcare in the best possible way. The crucial aim of optimization of available healthcare resources is obtaining the maximum possible benefit with the minimum expenditure. This has important social implications, whether individual citizens or tax-funded national health services eventually have to pay the bill. The keyword here is efficiency, which means either, maximizing the benefit from a fixed sum of money, or minimizing the resources required for a defined benefit. In order to achieve these objectives, economic evaluation is a helpful tool. Five different types of economic evaluation exist in the health-care field: cost-minimization, cost–benefit, cost-consequences, cost-effectiveness and cost-utility analysis. The objective of this narrative review is to provide an overview of the principal methods used for economic evaluation in healthcare. Economic evaluation represents a starting point for the allocation of resources, the decision of the valuable investments and the division of budgets across different health programs. Moreover, economic evaluation allows the comparison of different procedures in terms of quality of life and life expectancy, bearing in mind that cost-effectiveness is only one of multiple facets in the decision making-process. Economic evaluation is important to critically evaluate clinical interventions and ensure that we are implementing the most cost-effective management protocols. Clinicians are called to fulfill the complex task of optimizing the use of resources, and, at the same time, improving the quality of healthcare assistance.


      EE (economic evaluation), OECD (Organization for Economic Co-operation and Development), CEA (cost-effectiveness analysis), CER (cost-effectiveness ratio), ICER (incremental cost-effectiveness ratio), WTP (willingness to pay), NICE (National Institute for Health and Clinical Excellence), CUA (cost-utility analysis), QALY (quality adjusted life year), HUI (Health Utilities Index), SF-6D (Short-form 6D), EQ-5D (Euro Quality of life 5 Dimensions)


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