ABSTRACT
The practice of economic evaluation in health care takes a number of forms, and most of these are defined in terms of the ways in which benefits are measured. It is easy to be confused by the terminology used. Drummond et al. (2005) did their best to make things clear with detailed definitions of the hierarchy of types of evaluation from those comparing costs alone to full cost-benefit analysis, where all costs and benefits are measured in money terms. Several problems result from this attempt at standardisation. First, since practitioners normally ignore the suggested classification, terminology is normally used ‘incorrectly’. For example, the Journal of the American Medical Association published guidelines for economic evaluation that use the term cost-effectiveness analysis for what the Drummond classification would describe as cost-utility analysis. Second, this approach may lead to a tendency to see the different ways of measuring benefits as being different types of analysis, when in reality they are variants on a theme. Benefit measurement is normally difficult and placing a value on benefit is very difficult. The choice of type of evaluation to use is normally made on the basis of how difficult it is to obtain data that will allow benefits to be measured or valued.
