Best parameters for assessment

primary disease or its treatment. Direct costs include costs of physician visits,

diagnostic tests, prescription drugs, over-the-counter medication, hospital stay and

procedures, aid and devices and outpatient procedures.

Indirect cost: Indirect costs are more difficult to measure. Some can be given a

monetary value, although this is dependent on local systems of social support,

sickness benefits and pension. Lost of work productivity is important in chronic

musculoskeletal conditions but rarely is included in economic evaluations.

Intangible costs: Intangible costs are those associated with loss in function,

increased pain and reduced quality of life of patients, families and careers. These

include the costs of lost opportunities.These are very important for musculoskeletal

conditions, because disability is a significant outcome with limitation in activities

of daily living, reduction in leisure and community activities, chronic pain,

psychologic problems including depression and anxiety and reduced general

health.

cost-Effectiveness analysis : Cost Effectiveness Analysis (CEA) involves

comparing programs or treatment alternatives with different safety and efficacy

profiles. Cost is measured in rupees and outcomes are often expressed in efficacy

unit,anaturalunit,ornon-rupeesunits(i.e.livessaved,casescured,lifeexpectancy,

or drop in blood pressure in mm Hg, improved functional ability, disease activity

etc) (Bootman, Larson, Mcghan, Townsend, 1989; Detsky, Nagiie, 1990). The

results of Cost Effectiveness Analysis (CEA) are expressed as a ratio – either as

an average cost effectiveness ratio (ACER) or as an incremental cost effectiveness

ratio (ICER).

An Average CER represents the total cost of a program or treatment alternative

divided by its clinical outcome to yield a ratio representing the rupees cost per

specific clinical outcome gained, independent of comparators (Eisenberg, 1989;

Detsky, Nagiie, 1990; Sanchez, Lee, 1994). ACER = health care cost / Clinical

outcome.

An Incremental CEA may be used to determine the additional cost and the

effectiveness gained when one treatment alternative (A) is compared with the next

best treatment alternative (B).Thus, instead of comparing the average C/E ratio

of each treatment alternative, one over another treatment is compared with the

additional effect, benefit, or outcome it provides (Eisenberg, 1989).

ICER = cost A – cost B / effect A (%) – effect B (%).

clinical outcome

Clinical outcome are the medical events that occur as a result of disease or treatment

(e.g. safety and efficacy end points). The measures of clinical effectiveness in RA

are:

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