|  This is a useful and comprehensive addition to the
literature and a good, systematic guide to material of increasing importance
in terms of policy making. The National Institute for Health and Clinical
Excellence (NICE) is growing into its role of being the rationing agent
for the NHS
in England and Wales. Rationing or
depriving patients of care from which they would benefit and which they
desire is unavoidable and NICE’s role is to make a critical appraisal
of competing technologies to determine their relative cost effectiveness
and suitability for reimbursement in the NHS. Their appraisal technique
is economic evaluation.
After initial chapters on health economics and rationing, the authors
examine the concepts of cost (the value of what is given up when a therapy
is adopted) and benefit (the value of what is gained when a therapy is
adopted) before providing three lucid chapters on cost-effectiveness
analysis, cost-utility analysis and cost-benefit analysis. They then
proceed to examine the use of decision analysis, the use of economic
evaluation in decision making, statistical issues and valuing preferences.
All this is done with clarity, with each chapter having worked examples
of issues covered, eg, the use of discounting, self-directed study exercises,
references and further reading. The book is completed with a glossary
and index.
Inevitably, there are some problems. For instance, while efficacy is
defined in the text (p68), it is not included in the glossary. The discussion
of bias in randomised controlled trials might have offered more on statistical
power issues and the creation of bias due to commercial perversion of
trial design and
reporting.
Although nothing in life is perfect, this is a valuable addition to the
guidebook literature on economic evaluation. Hopefully, subsequent editions
will maintain the clarity of presentation as the subject literature develops
and becomes even more central to decision making in the NHS and every
other health care system.
Alan Maynard (professor of health economics at the University of York)
|
The
Pharmaceutical Journal