Cost-comparison analysis versus cost-effectiveness analysis: An important difference
Authors: Suephy Chen, Ahmed M. Bayoumi, Mary K. Goldstein
Journal: Journal of the American Academy of Dermatology (1999)

To the Editor:Cook and Zitelli are to be commended for their work in the cost analysis of Mohs micrographic surgery (J Am Acad Dermatol 1998;39:698-703). With the increasing presence of managed care, many leaders in dermatology have called for outcomes research and cost-effectiveness analyses. This article is a good response to the paucity of research into the least costly way to provide a dermatologic service. However, readers of the article and future researchers should realize that their analysis is not a cost-effectiveness analysis (CEA), but a cost comparison analysis.A CEA involves more than a comparison of costs. It also incorporates effectiveness. The Panel on Cost-effectiveness in Health and Medicine1Weinstein M Siegel J Gold M Kamlet M Russell L Recommendations of the Panel on Cost-Effectiveness in Health and Medicine.JAMA. 1996; 276: 1253-1258Crossref PubMed Scopus (0) Google Scholar has reached a consensus that CEAs are to be presented as a ratio of costs to effectiveness. Effectiveness incorporates both the efficacy of the two therapies being compared and the preferences of society for the outcomes that the therapies produce. One of the most popular ways to quantify these preferences is to use utility assessment. There are currently 2 published sources for dermatologic utilities.2Zug K Bittenberg B Baughman R et al.Assessing the preferences of patients with psoriasis.Arch Dermatol. 1995; 131: 561-568Crossref PubMed Scopus (90) Google Scholar, 3Chen S Shaheen A Garber A Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis: a pilot study.Arch Dermatol. 1998; 134: 1602-1608Crossref PubMed Scopus (23) Google Scholar Our group is currently working on a third source.A cost comparison analysis may be appropriate if all of the outcomes are similar. It then becomes what some have called a cost-minimization analysis. If there are differences in either or both survival and quality of life, these should be included in the analysis. Indeed, the authors make reference to the “value” of Mohs surgery but do not express it quantitatively. Utilities would be an accepted method to quantify that “value” and could actually strengthen their argument.We should emphasize the importance of the guidelines set forth by the Panel. Already in other fields of medicine, many of the CEAs that were performed before the guidelines were established were done in an ad hoc manner. It was impossible to compare one CEA to another. In this age of limited resource allocation, policy makers want to be able to compare one therapy with another, or one delivery system with another. The guidelines provide a means to make CEAs comparable. If dermatologists are to demonstrate that they are cost-effective in caring for skin, we must provide CEAs that convey useful information and that can be compared with other CEAs. To the Editor:Cook and Zitelli are to be commended for their work in the cost analysis of Mohs micrographic surgery (J Am Acad Dermatol 1998;39:698-703). With the increasing presence of managed care, many leaders in dermatology have called for outcomes research and cost-effectiveness analyses. This article is a good response to the paucity of research into the least costly way to provide a dermatologic service. However, readers of the article and future researchers should realize that their analysis is not a cost-effectiveness analysis (CEA), but a cost comparison analysis.A CEA involves more than a comparison of costs. It also incorporates effectiveness. The Panel on Cost-effectiveness in Health and Medicine1Weinstein M Siegel J Gold M Kamlet M Russell L Recommendations of the Panel on Cost-Effectiveness in Health and Medicine.JAMA. 1996; 276: 1253-1258Crossref PubMed Scopus (0) Google Scholar has reached a consensus that CEAs are to be presented as a ratio of costs to effectiveness. Effectiveness incorporates both the efficacy of the two therapies being compared and the preferences of society for the outcomes that the therapies produce. One of the most popular ways to quantify these preferences is to use utility assessment. There are currently 2 published sources for dermatologic utilities.2Zug K Bittenberg B Baughman R et al.Assessing the preferences of patients with psoriasis.Arch Dermatol. 1995; 131: 561-568Crossref PubMed Scopus (90) Google Scholar, 3Chen S Shaheen A Garber A Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis: a pilot study.Arch Dermatol. 1998; 134: 1602-1608Crossref PubMed Scopus (23) Google Scholar Our group is currently working on a third source.A cost comparison analysis may be appropriate if all of the outcomes are similar. It then becomes what some have called a cost-minimization analysis. If there are differences in either or both survival and quality of life, these should be included in the analysis. Indeed, the authors make reference to the “value” of Mohs surgery but do not express it quantitatively. Utilities would be an accepted method to quantify that “value” and could actually strengthen their argument.We should emphasize the importance of the guidelines set forth by the Panel. Already in other fields of medicine, many of the CEAs that were performed before the guidelines were established were done in an ad hoc manner. It was impossible to compare one CEA to another. In this age of limited resource allocation, policy makers want to be able to compare one therapy with another, or one delivery system with another. The guidelines provide a means to make CEAs comparable. If dermatologists are to demonstrate that they are cost-effective in caring for skin, we must provide CEAs that convey useful information and that can be compared with other CEAs. Cook and Zitelli are to be commended for their work in the cost analysis of Mohs micrographic surgery (J Am Acad Dermatol 1998;39:698-703). With the increasing presence of managed care, many leaders in dermatology have called for outcomes research and cost-effectiveness analyses. This article is a good response to the paucity of research into the least costly way to provide a dermatologic service. However, readers of the article and future researchers should realize that their analysis is not a cost-effectiveness analysis (CEA), but a cost comparison analysis. A CEA involves more than a comparison of costs. It also incorporates effectiveness. The Panel on Cost-effectiveness in Health and Medicine1Weinstein M Siegel J Gold M Kamlet M Russell L Recommendations of the Panel on Cost-Effectiveness in Health and Medicine.JAMA. 1996; 276: 1253-1258Crossref PubMed Scopus (0) Google Scholar has reached a consensus that CEAs are to be presented as a ratio of costs to effectiveness. Effectiveness incorporates both the efficacy of the two therapies being compared and the preferences of society for the outcomes that the therapies produce. One of the most popular ways to quantify these preferences is to use utility assessment. There are currently 2 published sources for dermatologic utilities.2Zug K Bittenberg B Baughman R et al.Assessing the preferences of patients with psoriasis.Arch Dermatol. 1995; 131: 561-568Crossref PubMed Scopus (90) Google Scholar, 3Chen S Shaheen A Garber A Cost-effectiveness and cost-benefit analysis of using methotrexate vs Goeckerman therapy for psoriasis: a pilot study.Arch Dermatol. 1998; 134: 1602-1608Crossref PubMed Scopus (23) Google Scholar Our group is currently working on a third source. A cost comparison analysis may be appropriate if all of the outcomes are similar. It then becomes what some have called a cost-minimization analysis. If there are differences in either or both survival and quality of life, these should be included in the analysis. Indeed, the authors make reference to the “value” of Mohs surgery but do not express it quantitatively. Utilities would be an accepted method to quantify that “value” and could actually strengthen their argument. We should emphasize the importance of the guidelines set forth by the Panel. Already in other fields of medicine, many of the CEAs that were performed before the guidelines were established were done in an ad hoc manner. It was impossible to compare one CEA to another. In this age of limited resource allocation, policy makers want to be able to compare one therapy with another, or one delivery system with another. The guidelines provide a means to make CEAs comparable. If dermatologists are to demonstrate that they are cost-effective in caring for skin, we must provide CEAs that convey useful information and that can be compared with other CEAs.