Page 28 - Htain Manual

Cost minimisation analysis is the simplest type of economic evaluation which assumes

that the consequences (the health gain) arising from the use of the health technologies

compared are the same. Therefore, it is sufficient to assess the costs of both the alternatives.

In cost-effectiveness analysis, both the costs and consequences arising from use of the health
technologies are identified, measured and valued and compared. The consequences are

assessed in natural units, e.g., mm Hg reduction in systolic blood pressure, cases prevented,

lives saved, life years gained. Cost-utility analysis differs from cost-effectiveness analysis in
that the consequences are measured and valuated in the form of quality-adjusted life years

(QALYs). The years of life gained are therefore quality-adjusted with health-related quality of

life in order to assess QALYs. This kind of analysis makes it possible to compare outcomes of

interventions across different activities in the health care sector, where natural units of

outcomes are different otherwise. Cost-benefit analysis is the broadest type of economic
evaluation where both the costs and consequences are measured and valued in monetary

terms, net gain can therefore be calculated directly.

Economic evaluations provide evidence on how to maximize health benefits within a

given budget, accounting for the societal value of health. It, however, does not generally
provide information about the distributional value of health benefits in a given setting.

Therefore, apart from comparing the health and economic consequences of available policy

options, HTA also assesses their feasibility of implementation with regard to social, legal and
ethical aspects. Social aspects such as effect on out of pocket expenditure, catastrophic health

expenditure, impoverishment rates are assessed with the help of equity analysis, so that the

proposed health technology confers to the principles of distributional justice. Equity analysis

can be performed by using mathematical programming, measurement of distribution of

opportunity costs, multi-criteria decision analysis, distributional cost-effectiveness analysis
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(DCEA) and extended cost-effectiveness analysis (ECEA). However, as the term inequity goes
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beyond measurable differences in health status to include moral and ethical dimensions also ,
all the organizational, legal and ethical issues are assessed with the help of stakeholders’
discussions.

Practice of HTA

HTA provides an internationally-accepted and structured approach to form the basis

for evidence-based priority setting and policy decisions. It is widely used to inform healthcare

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