Læknablaðið - 15.08.1995, Page 40

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LÆKNABLAÐIÐ 1995; 81
and consequences associated with different
forms of health care intervention. Such eval-
uations provide frameworks for assisting deci-
sion makers to make choices. Ideally, socioec-
onomic evaluations should be performed
alongside clinical trials.
In cost-effectiveness analysis the costs are
compared with outcomes measured in natural
units, such as per cases treated appropriately,
per lives saved, per pain free days, per compli-
cations avoided. In cost-utility analysis the
costs of different procedures and their out-
comes are measured in units that relate to an
individual’s wellbeing, such as quality adjusted
life year (QALY). Cost-benefit analysis is the
most comprehensive method of socioeconomic
evaluation, and it has been used as an aid to
decision making in many different areas of
health care policy making. Cost-benefit analy-
sis places monetary values on both the inputs,
or costs, and outcomes, or benefits, of health
care.
An important step in the overall socioec-
onomic approach is to set the socioeconomic
baseline. This includes basic disease data, pat-
terns of disease management, and assessment
of risks, costs and benefits. Costs are economic
inputs required to achieve a certain output.
Examples of direct costs are personnel and
material expenses. Examples of indirect costs
are income losses, loss of working time, and
psychological distress. Benefits are the out-
comes resulting from the intervention. Exam-
ples of direct benefits are reduction of material
and personnel costs, and avoidance of future
treatment costs. Indirect benefit is for instance
improved working or production capacity.
So called decision tree analysis can be used
in a wide range of socioeconomic analyses. It is
a quantitative technique which measures the
overall performance of a specific health care
intervention, such as a new diagnostic test. In
the decision tree model each brand of the tree
requires specific input data. The application of
PCR-based diagnostic test for C. trachomatis
in women (to see whether women can benefit
from PCR-based diagnostic testing) requires
data of test characteristics, probabilities of
clinical outcomes of Chlamydial infection in
women, and socioeconomic advantages. The
key question is whether finding of asympto-
matic infections is cost-effective in a low preva-
lence population.
Table II. Socioeconomic evaluation of health care interven-
tions.
Cost-effectiveness analysis
Natural units (e.g. lives saved, cases appropriately
diagnosed etc.)
Cost-utility analysis
Quality adjusted life years (QALY)
Cost-benefit analysis
Monetary values of inputs (costs) and outputs
(benefits)
Table III. Cost of a universal screening program*.
No. of cases FIM (millions)
Screening (Amplicor™ PCR) 390,000 26.5
Antibiotic treatment** 1.2
Total 27.7
* Target 65% of total population in the age group of
15-24
** Estimated prevalence 5%
Table IV. Estimated annual cost of sequelae of Chlamydial
infections in women in Finland.
No. of cases FIM (millions)
Acute PID* 2400 27
Subclinical PID** 5800 11
Tubal infertility*** 1300 66
Tubal pregnancy**** 1800 15
Chronic pelvic pain***** 1000 7
Total 129
20% develop acute PID
Menometrorrhagia, vaginal discharge, low ab-
dominal pain, dysuria
*** 30,000 new couples/year, infertility rate 17%,
TFI 25%; Rx IVF
**** 3% of all pregnancies, operative laparoscopy
***** Laparoscopy
Magnitude of the cost of short-term and long-
term consequences of C. trachomatis infections:
Table III shows a very preliminary estimate
of annual costs of the diagnosis and treatment
of Chlamydial infections in Finland. Of the
estimated 20,000 sexually transmitted Chlamy-
dial infections occurring annually in Finland
approximately 60% (12,000) are detected in
women. Of all Chlamydia cases, 60% are seen
in patients under 25 years, and the loss of
fertility is most tragic among these young
women. Approximately 20% (2400) of these