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Cost of Illness Studies

Another type of economic evidence that appears in the medical literature comes from cost of illness studies. Cost of illness studies, also commonly known as burden of illness studies, set out to determine the overall resource consumption associated with a specific illness. Often this is presented in monetary terms and is focused on health care resources. Originally, cost of illness studies covered all major diseases for the purposes of advocating to government for additional health care spending. Lately, studies have been narrower in scope and used for awareness of a specific disease. The purpose of disease-specific cost of illness studies is often to present the case for additional research, funding for care or raise awareness for a specific disease. Table 1 outlines the strengths and weaknesses of each type of economic study design.

Table 1: Strengths and Weaknesses of Varying Types of Economic Evaluations

Type of studyHow are benefits captured?Primary outcomeStrengthsWeaknesses
Cost Benefit AnalysisAs costs (often through willingness to pay)Incremental cost·        Captures all costs and benefits in one number (cost)

·        Includes patient preference in benefit calculation

·        Whether intervention is cost effective is easy to measure

·        Least reported type of economic analysis in published literature

·        Different methods for calculating benefits


Effectiveness Analysis

Through clinical outcomesCost per clinical outcome·        Includes clinical outcomes that clinicians in the field are familiar with

·        Easy to incorporate clinical trial data

·        Difficult to compare across different disease groups

·        Does not incorporate quality of life/patient preferences

·        Whether intervention is cost effective requires a willingness to pay threshold

Cost Utility AnalysisIn the form of quality of life utilitiesCost per quality-adjusted life year·        Can compare results across different studies and disease groups

·        Widely accepted as the preferred economic evaluation by decision making bodies

·        Often utility values have not been measured

·        Different utility measurement tools provide variable results

Cost of IllnessNoneCost·        Captures the economic burden of a medical condition

·        Easily understood by non-academics

·        Does not incorporate clinical outcomes or patient preferences

·        Often calculated as gross costs and not disease specific costs

With economic evidence playing an increasing role in health care decision making and government advocacy, there is a need for a review of the current state of economic research in the area of SCI. The purpose of this review was to describe the breadth of research, and to identify the current limitations and areas for future studies relevant to the SCI population.

Specifically, this chapter will review the economic evaluation studies (cost-effectiveness, cost-utility and cost-benefit) and cost of illness studies in SCI.