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Economic evaluations are increasingly carried out alongside clinical evaluations so that the clinician is presented with information on both the effectiveness and cost-effectiveness of alternative treatments to inform their evidence based practice. These evaluations are important on both theoretical and policy grounds. An economic evaluation is made up of a number of components, the most important of which are a comparison group, a stated perspective, evidence of costs, evidence of effectiveness and a method of combining costs and effects together. Cost-effectiveness, cost-utility and cost–benefit analyses are different methods of economic evaluation in common use and they are described with examples.
Evidence based medicine and evidence based decision making are very much a part of modern psychiatric practice. They involve the use of current best evidence in making decisions for the care of individual patients.1 The main tool used by researchers to supply information to clinicians on best practice is the randomised controlled trial (RCT), which in mental health service research is often applied in a pragmatic manner. Pragmatic RCTs are designed so that their results are applicable to routine clinical practice; they aim to reflect the heterogeneity of patients in routine practice through minimisation of exclusion criteria, a focus on groups with a range of diagnoses and classification of patient groups by presentation at services rather than by diagnosis.2 It is increasingly common for such pragmatic trials to include an economic evaluation component, in which the costs of the treatments under evaluation are analysed alongside the effects. This article seeks to explain why economic evaluations are carried out, to explain what exactly they are, to equip the reader with the necessary information to confidently understand them and, we hope, to encourage the reader to consider the results of such evaluations as part of their evidence based practice.
WHY ECONOMIC EVALUATION?
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