Health economics in surgery

Economic evaluations are a vital component for decision-making and may run alongside trials or be integrated into to evaluations of complex interventions or complex systems. In this paper two economic principles of cost will be discussed, opportunity cost and marginal cost, which are central to economic assessments. The position of economic evaluation within the new Medical Research Council framework for evaluating complex interventions will then be illustrated. Complex interventions, defined as a series of interacting factors within a treatment or intervention, are widely found in surgical healthcare and it has been suggested that evaluation should take a whole systems approach. Four differing types of evaluation (cost-benefit analysis; cost-effectiveness analysis, cost-utility analysis, and cost-consequence analysis) are described and the most appropriate design for evaluations at a local level are discussed. Perspectives taken for the evaluation will affect the costs and benefits considered and will produce differing results. Hence it becomes important to understand from which perspective (societal, organizational, patient, surgeon, NHS) the evaluation is conducted.