Cost-Consequence Analysis

Types

When a CCA is performed as a variant of a CEA, it takes an incidence-based perspective and estimates the costs and consequences for an individual or disease cohort for as long as the health condition lasts. However, a CCA also can be performed from a prevalence-based perspective, where the costs and consequences of alternative mixes of interventions can be compared over a 1-year time frame for a population with the condition of interest. This type of analysis is an expanded version of a budget impact analysis (BIA). Health and other consequences of the alternative mixes of interventions are presented annually for the population, as are the costs, which are aggregated by cost category.

Since a single overall number is not generated as a result of a CCA, the perspective does not have to [Page 209]be chosen by the analyst. The perspective of a CCA should be as broad as possible, since the user of the analysis should be able to view a comprehensive listing of the various costs and consequences of alternative interventions. The user then can choose which variables are relevant for their perspective and can ignore the others.

Time Horizon

The time horizon for a CCA should be chosen in the same way as the time horizon for the CEA, the cost-utility analysis (CUA), or the BIA. For an incidence-based CCA, the time horizon will vary, depending on the health condition and the type of intervention, as shown in Figure 1. The duration of the impact of the intervention on the individual with the health condition is the primary determinant of the appropriate time horizon, with acute nonfatal illness requiring a shorter time horizon and chronic or fatal illness requiring up to a lifetime time horizon. Whether or not a healthcare intervention is for prevention or treatment also is a determinant of the appropriate time horizon for the analysis. For a prevalence-based CCA, the chosen time horizon should be relevant to the decision maker. Typically, annualized costs and consequences for 1 to 5 years after a change in treatment patterns is the most relevant time horizon.

Scope

As with other types of economic evaluation, the question of scope of the analysis is important: For example, with interventions that affect life expectancy, should the costs and consequences of alternative interventions include their impact only on condition-related outcomes, or should the impact on healthcare costs and outcomes for other conditions be considered? Generally, costs and consequences for unrelated health conditions are not considered in economic evaluations. Also, which specific costs and consequences should be included is less restricted in a CCA than in a typical CEA or CUA. For a CCA, outcomes may be included that are not typically part of a CEA, a CUA, or a BIA, such as social service costs and dosing convenience. Finally, alternative interventions may have different impacts on different population subsets, and a separate analysis for these different population subsets is important for all types of economic evaluations, including the CCA.

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