Documents Gray, Alastair 2 results

"The techniques of economic evaluation have been increasingly widely applied in the health sector over recent decades, with hundreds of published evaluations performed in many countries and ranging across prevention programmes, diagnostics, treatment interventions, and the organization of health care. This paper examines the main methods in current use, and describes the gradual systematization of economic evaluation methodologies and the increasing importance of reimbursement agencies with explicit technical requirements. It reviews controversies in areas such as discounting, analytic perspective, identifying a cost-effectiveness threshold, differential treatment of particular disease areas or treatment groups, and the valuation of outcomes. It then considers in more detail the development of the World Health Organization's generalized cost-effectiveness framework, and the emergence of an international ‘reference case' commissioned by the Bill & Melinda Gates Foundation as a way of increasing the generalizability and comparability of such studies. Finally the paper discusses some current controversies and possible future developments in this field."

"Background
In 2008, 2·45 million people were diagnosed with cancer and 1·23 million died because of cancer in the 27 countries of the European Union (EU). We aimed to estimate the economic burden of cancer in the EU.

Methods
In a population-based cost analysis, we evaluated the cost of all cancers and also those associated with breast, colorectal, lung, and prostate cancers. We obtained country-specific aggregate data for morbidity, mortality, and health-care resource use from international and national sources. We estimated health-care costs from expenditure on care in the primary, outpatient, emergency, and inpatient settings, and also drugs. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients (ie, informal care), lost earnings after premature death, and costs associated with individuals who temporarily or permanently left employment because of illness.

Findings
Cancer cost the EU €126 billion in 2009, with health care accounting for €51·0 billion (40%). Across the EU, the health-care costs of cancer were equivalent to €102 per citizen, but varied substantially from €16 per person in Bulgaria to €184 per person in Luxembourg. Productivity losses because of early death cost €42·6 billion and lost working days €9·43 billion. Informal care cost €23·2 billion. Lung cancer had the highest economic cost (€18·8 billion, 15% of overall cancer costs), followed by breast cancer (€15·0 billion, 12%), colorectal cancer (€13·1 billion, 10%), and prostate cancer (€8·43 billion, 7%).

Interpretation
Our results show wide differences between countries, the reasons for which need further investigation. These data contribute to public health and policy intelligence, which is required to deliver affordable cancer care systems and inform effective public research funds allocation."