How Health Economics Will Improve Clinical Trials to Maximize Health

Due to the increasing urgency of accessing healthcare services, and a patient-centric approach, decisions need to be more open, fair, and empowering of patient opinions. Health economics guarantees a decision-making framework.

viders, public/private organizations, and governments. Therefore, health economics is implemented to promote health by applying theories of production, efficiency, competition, regulation, policies, evaluation of advanced technologies, investments, and strategic behavior.

What goods and services should we produce and how? Who should receive these services?

This discipline aims to answer simple questions by assuming the approach of generating and efficiency-maximizing benefits of resources.

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Why should health economics be integrated into medical systems?

A few decades ago, any medical decisions were based on implicit values and determined exclusively by the physician. By contrast, due to the increasing urgency of accessing healthcare services, and a patient-centric approach, decisions need to be more open, fair and empowering of patient opinions. Therefore, health economics would guarantee a decision-making framework to organize operations addressing a wide range of healthcare challenges. Health economists are involved in the production of health operating at different levels from planning, budgeting, monitoring, and evaluating decisions to generate novel values and better healthcare delivery.

Furthermore, economic evaluation is central in this discipline because it aims at enhancing efficient choices in healthcare among different economic principles such as opportunity costs valuing the service and outcome, consumer/provider perspectives, and marginal analysis to estimate resources invested and benefits. Thus, the economic evaluation will measure and analyze the benefits of the:

Cost minimization: analysis of costs between different interventions (generating the same consequences), where the most convenient intervention is selected.
Cost-efficient: programs and treatments with the same health outcome are compared and the one with the most efficient results, based on a ratio scale, is selected.
Cost-utility: analysis to assess costs and benefits of different interventions/programs to promote health longevity and life quality (e.g., when a new drug has higher costs and benefits over another, it should be calculated whether paying extra costs is worth the benefits gained).
Cost-benefit: the analysis of costs and consequences of a treatment on a monetary basis. Hence, if the benefits are less than the costs, the treatment is considered convenient and accepted.
Cost consequences: it is a different method to look at costs and benefits when making a decision. Thus, costs and outcomes are evaluated and presented separately while avoiding the decision-making processes to be affected by potential bias.

Health economics in clinical research

The demonstration that a new therapy is effective, is no longer sufficient to guarantee the best healthcare practice. Indeed, the increasing need for resources supporting care services, besides higher costs in developing novel treatments, constantly requires funds and finances. This process would influence those professionals in charge of deciding on whether a new treatment should be pursued even when available resources are limited. Therefore, an economic evaluation may be applied to estimate costs and benefits from the perspective of optimal clinical outcomes [1]. This fact is particularly true in the context of clinical trials in which a closer examination of the relationship between health outcomes and costs determines the viability of the study.

Accordingly, the result of this economic evaluation, based on a consistent set of data, would influence the choice of potentially adopting innovative technologies (e.g., diagnostic devices) based on the reimbursement costs, and thus an early estimation would be also necessary regarding the fulfillment of regulatory approvals. For this reason, to have better guidance in conducting proper economic evaluations in clinical trials, the book by Glick et al (2015) [2] on economic evaluation in clinical trials covers issues and techniques associated with the collection of costs and outcome data. Besides, it proposes a framework and a methodology (e.g., made of examples and exercises) for reporting and interpreting economic outputs related to clinical trials, thus supporting the reader in this learning process with applicable and practical solutions.