Economic evaluation and end-stage renal disease: From basics to bedside

Economic evaluation is the comparative analysis of alternative health care interventions in terms of their relative costs (resource use) and effective ness (health effects). High-quality studies of economic evaluation have bee n increasingly published in medical journals and read by clinicians, althou gh publication of these studies in nephrology journals has been a more rece nt phenomenon. This article shows how the basic principles of economics can be applied to health care through the use of economic evaluation. Differen t types of economic evaluation are discussed, and pitfalls common to such s tudies are identified. A simple framework is introduced that can be used to interpret the results of economic evaluations. Using this framework, selec ted therapies for patients with end-stage renal disease (ESRD) are categori zed to highlight therapies that are very efficient, encourage their use, an d draw attention to therapies in current use that are less effective and mo re expensive (ie, less efficient) than alternative therapy. Using examples pertinent to care of the patient with ESRD, we show how economic evaluation can be used to link medical outcomes, quality of life, and costs in a comm on index for multiple therapies with disparate outcome measures. This artic le highlights the need for clinical studies and economic evaluations of the rapies in ESRD for which the effects of the therapy on health outcomes and/ or costs are unknown. (C) 2000 by the National Kidney Foundation, Inc.