1 Introduction
Economic evaluations of health technologies have been used as a tool for assisting
reimbursement decisions in the area of health care, with the goal of enhancing the
economic efficiency and optimizing resource allocation. Broadly speaking, eco-
nomic evaluation is the comparative analysis of alternative courses of action in
terms of both their costs and consequences.^1 Economic evaluations produce evi-
dence on cost-effectiveness of health technologies, which are at the core of the
value assessment in the process of Health Technology Assessment (HTA). HTA is a
multidisciplinary assessment of the range of social, economic, clinical, and orga-
nizational consequences stemming from the introduction of a new technology into
the health care system, relative to the existing standards of care. HTA decisions
represent an important element within the complex decision-making process that
governs the process of funding and access to health technologies in various health
care systems and is especially relevant for the reimbursement of pharmaceuticals.^2
Here we focus on a key aspect of HTA: the economic evaluations of new health
technologies.
Economic evaluations became reasonably well accepted in decision making
within the health care systems in different jurisdictions^3 because they offer a
promise of a systematic and transparent framework for deciding which interven-
tion—among competing interventions—to fund from a restricted budget. That is,
once effectiveness and efficacy have been established, decision makers can use the
evidence on cost-effectiveness of competing interventions to decide which inter-
vention to fund and thus maximize the aggregate (value of) health benefits attained.
Economic evaluations have been gaining importance for reimbursement decisions
in different jurisdictions, mostly within the health care systems supporting universal
health insurance coverage, as in the UK, the Netherlands, Australia, or Canada. The
information about the cost-effectiveness of health technologies makes up the final,
“fourth hurdle” in the process of health technology development, in the stage of
market access, pricing, and reimbursement. Many jurisdictions, such as Australia,
the UK, or the Netherlands, explicitly require economic evaluations for reimburse-
ment decisions, predominately concerning the reimbursement of drugs.^4 However,
a new challenge facing economic evaluations is emerging. Developments in med-
icine, bio- and nano-technology are looking to change the way we understand,
prevent, and treat diseases, which in turn may affect the way we understand and
conduct HTA in general and economic evaluations in particular. This new approach
is termed “personalized medicine,” and it moves away from the common and
currently predominant “one size fits all” medical model (e.g., a single drug being
(^1) For further details, see Drummond et al. ( 1997 ).
(^2) For more details, National Institute for Health and Care Excellence (NICE) ( 2013 ).
(^3) Further discussion on this topic available from Drummond ( 2012 ), pp. 1–16.
(^4) For examples of country-specific guidelines, see NICE ( 2013 ) and Netherlands College van
Zorgverzekeringen (CVZ) ( 2006 ).
108 A. Bobinac and M. Vehovec