Economic evaluation of care for the chronically ill: A literature review

Financial problems of governments and the consequent urge toset limits on health care growth have increased the importanceof economic rationalization. A systematic review of the presentbody of knowledge might facilitate the need to set prioritiesin health care policies and research in an ageing society withgrowing numbers of the elderly and chronically ill. After explainingthe purpose and methods of full economic evaluation, we reviewthe literature on 3 major chronic diseases, diabetes mellitus(20 publications), rheumatoid arthritis (15) and chronic obstructivepulmonary disease (COPD) and asthma (8). This review serves2 objectives: to review the existing literature and to assessits quality. The review reveals a lack of full economic evaluationin this sector of health care. The total number of referencesto the specified chronic diseases covers 5% of all economicliterature and 44% of all references under Index Medicus' heading‘economics’, while the burden of illness is substantial,resulting in high indirect costs to the patients themselvesand to society. The dominant approach is cost-effectivenessanalysis (71%), followed by cost-benefit analysis (20%). Cost-utilityanalysis is rare (9%), partly because it is still in the phaseof development. However, this approach can deal better withthe objectives of many interventions in chronic care, i.e. increasingthe quality rather than the quantity of life. We make a pleafor full economic evaluation of chronic care programmes andfor the development of quality of life measures which coverthe broad domain of well-being of the chronically ill.