The death of cost‐minimization analysis?

Abstract

Four different types of evaluation methods, cost-benefit analysis (CBA), cost-utility analysis (CUA), cost-effectiveness analysis (CEA) and cost-minimization analysis (CMA), are usually distinguished. In this note, we pronounce the (near) death of CMA by showing the rare circumstances under which CMA is an appropriate method of analysis. We argue that it is inappropriate for separate and sequential hypothesis tests on differences in effects and costs to determine whether incremental cost-effectiveness (or cost-utility) should be estimated. We further argue that the analytic focus should be on the estimation of the joint density of cost and effect differences, the quantification of uncertainty surrounding the incremental cost-effectiveness ratio and the presentation of such data as cost-effectiveness acceptability curves. Two examples from recently published CEA are employed to illustrate the issues. The first shows a situation where analysts might be tempted (inappropriately) to employ CMA rather than CEA. The second illustrates one of the rare circumstances in which CMA may be justified as a legitimate form of analysis. Copyright © 2001 John Wiley & Sons, Ltd.

Cost-minimisation analysis of pegylated liposomal doxorubicin hydrochloride versus topotecan in the treatment of patients with recurrent epithelial ovarian cancer in Spain

“…The goal is to find the least expensive way of achieving the specific outcomes (Robinson, 1993;Basskin, 1998;Briggs and O'Brien, 2001). …”

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications

“…All unit costs employed followed well established guidelines on costing health and social care services as part of an economic evaluation. 1 [8][9][10][11][12][13][14][15][16][17][18][19][20] The calculation of these costs was underpinned by the concept of opportunity cost, which can be defined as the value of the next best alternative for using these resources. [18][19][20] If the hospital departments could not supply the researchers with specific cost information, this was then taken from available published sources.…”

“…This employed an economic hypothesis of 'weak dominance', hypothesising that the Birth Centre was as safe but less costly than the nearest hospital 15 .The study was conducted from a health system perspective and consequently only direct costs to the NHS were included. The time horizon identified women at the start of their care in labour and was completed when intrapartum and related in-patient postnatal care for mother and baby ended.…”

A randomised trial of endobronchial ultrasound guided sampling in peripheral lung lesions

“…The paper did not present sensitivity analyses of the results. A cost-minimisation analysis reveals the least costly strategy to a common end-point, a cost-effectiveness analysis might be better (198). When a centre wants to interpret the results from the economical analyses, the sensitivity analyses might be more valuable than the main results.…”