Health care economic analyses and value-based medicine

Health care economic analyses are becoming increasingly important in the evaluation of health care interventions, including many within ophthalmology. Encompassed with the realm of health care economic studies are cost-benefit analysis, cost-effectiveness analysis, cost-minimization analysis, and cost-utility analysis. Cost-utility analysis is the most sophisticated form of economic analysis and typically incorporates utility values. Utility values measure the preference for a health state and range from 0.0 (death) to 1.0 (perfect healthy). When the change in utility measures conferred by a health care intervention is multiplied by the duration of the benefit, the number of quality-adjusted life-years (QALYs) gained from the intervention is ascertained. This methodology incorporates both the improvement in quality of life and/or length of life, or the value, occurring as a result of the intervention. This improvement in value can then be amalgamated with discounted costs to yield expenditures per quality-adjusted life-year ($/QALY) gained. $/QALY gained is a measure that allows a comparison of the patient-perceived value of virtually all health care interventions for the dollars expended. A review of the literature on health care economic analyses, with particular emphasis on cost-utility analysis, is included in the present review. It is anticipated that cost-utility analysis will play a major role in health care within the coming decade.