Design Principles for Economic Evaluations in Pharmacy

Economic evaluations are designed to systematically approach a “decision problem.” Each decision problem is comprised of a question of which of a set of options appears to be most efficient, where this comparison occurs in terms of both costs and benefits. This approach still leaves significant scope for those conducting the economic evaluation to choose which costs and which benefits are considered to count. The first of these questions is often resolved in terms of who is the study being done for (i.e., who is the funder and what are their requirements). The second of these questions is harder to answer, and there are several factors that determine how appropriate it is to consider more ambitious, final outcomes such as quality-adjusted life years, as opposed to proxy outcomes or those that represent a nexus for treatment decisions within the clinical pathway. Using a series of examples including some from existing recent evaluations in pharmacy settings, this chapter will consider how to apply the logic of economic evaluation to select a form of economic evaluation that is appropriate to the decision problem faced.