Safety and efficacy are not the only parameters of interest for choice of medical technology - costs play an increasingly important role. There is a growing interest in 'value for money', which can be assessed by economic evaluation comparing the costs and consequences of alternative courses of action. A number of different economic evaluation methods may be used: cost-minimization (looking only at costs with no consideration of consequences); cost-effectiveness (in which a unidimensional clinical outcome is assessed, for example, life-years gained); cost-utility (measuring multidimensional outcomes, for example quantity and quality of life); and cost-benefit (where outcome is considered in monetary terms). A Swedish cost-of-illness study showed that the direct health care costs increased and the indirect cost (in terms of production loss) associated with treatment of peptic ulcer fell following the introduction of H-2-receptor antagonists. In a study of reflux oesophagitis, omeprazole was shown to be more cost-effective than ranitidine. With omeprazole, the costs were lower and the effectiveness better than with the H-2-receptor antagonist.
