CLINICAL ECONOMICS REVIEW - GASTROENTEROLOGY

In the prevailing climate of cost containment, doctors are increasingl y expected to consider the economic consequences of treatment choices, Clinical (or medical) economics attempts to apply economic principles to the description and analysis of the costs of medical interventions , so as to identify how best to spend scarce health care resources, Su ch economic evaluations may assess the overall financial burden of a d isease to society as a whole (macro-economics), or attempt to compare alternative treatment strategies for a specific clinical situation (mi cro-economics). In addition to expenditure on drugs and investigations (direct medical costs), economic studies may consider a variety of ot her costs, These include direct costs borne by patients (e.g, prescrip tion charges, travel, food), indirect costs to society owing to lost p roductivity (resulting from morbidity or premature mortality) and even intangible costs which assign a monetary value to outcomes of disease such as pain, distress and anxiety, Four main types of economic analy sis are in current use, Cost-minimization analysis attempts to identif y the least expensive option in situations where there are a range of equally effective treatments for a given clinical condition, whereas c ost-effectiveness analysis allows management strategies differing both in cost and efficacy to be compared, The cost-effectiveness of health care programmes targeting different disease states may also be compar ed using cost-utility analysis, in which health benefits are translate d into a common utility-based unit of outcome, such as the Quality Adj usted Life Year (QALY), Cost-benefit analysis attempts to quantify hea lth outcomes in monetary terms, so that the net result provides an ass essment of value-for-money of health interventions, Gastrointestinal d isorders are amongst the commonest of complaints, and considerable hea lth care resources are consumed in treatment. Issues of cost-effective ness are likely to assume increasing importance in gastroenterology be cause of the ever expanding range of drug choice, the increasing numbe r of high cost treatments and the development of new therapeutic inter ventions.