Valuing cost in cost utility analysis of screening programme.

The authors of the paper ‘Costeffectiveness of a community-based screening programme for chronic atrial fibrillation in Japan’ aimed to perform a cost-utility analysis of an annual community screening programme and to compare three strategies: annual screening with ECG, annual screening with pulse palpation for arrhythmia followed by ECG when arrhythmia was detected, and no screening. The authors attempted to estimate costs for the screening programmes retrospectively, using literature reviews from different countries, National Authority reports on salaries and budgetary line items. This is not appropriate for economic evaluation because not all costs are taken into account and the method can lead to misinterpretation of the real cost of intervention. Both tangible and intangible items must be taken into account in calculating the costs, regardless of whether they are used by and accrue to health services, society or the individual. The authors have missed the opportunity to estimate costs separately for each screening and then calculate the costs for each patient. Costs should include all follow-up visits (administration, clinical examination, consumables), ECGs (consumables, staff, annual equivalent costs for equipment, processing and reporting costs), and palpation (processing and reporting costs, staff). Costs for some resources, for example rent, may vary because of market forces, so it is best to present results not only in monetary values but also as the quantity of resources used. In addition to the costs accrued in providing screening services, the authors should also consider the costs and benefits to society (saved money due to early diagnosis) and individuals (money spent or salary lost due to participation in the screening programme, improved quality of life) and only then should they estimate the cost-utility ratio. As recommended by the health economics guidelines, the best design for economic evaluation is to perform a follow-up study assigning values to resources by defining costs at the same time, and with the same degree of accuracy, as outcome data. The economic definition of costs should be used in cost valuation rather than the financial definition. This concept implies that all resources consumed by an intervention should be costed, not just those constituting a budgetary line item.