Cost consequence analysis: health economic studies
How to use a cost consequence analysis to evaluate your digital health product.
This guidance is part of a collection of guidance on evaluating digital health products.
Cost consequence analysis (CCA) is one type of economic evaluation. CCA assesses a wide range of costs and consequences (effects) of the products you are comparing and reports them separately. It includes all types of effects, including health, non-health, negative and positive effects, both to patients and other parties (for example, caregivers).
CCA aims to give decision makers a comprehensive summary of the different costs and effects, so it tends to take a broad perspective. Decision makers might be, for example:
- local and national health commissioners
- budget holders
- government agencies
CCAs show results for different costs and effects separately, so each decision maker can choose which costs and effects are most relevant to their local context and viewpoint. For instance, some decision makers may decide to take the perspective of the NHS and only consider costs to the healthcare system and health benefits to the patient. Others may take a broader perspective, such as a societal perspective.
Decision makers will need to choose their own weighting system to decide whether the benefits of your digital product are worth the possible additional cost. For example, some decision makers may place higher value on the effects of your product on reducing health inequalities, whereas others may be mostly interested in how your product enables them to deliver healthcare more efficiently.
What to use it for
Use a cost consequence analysis when:
- your digital product is being piloted and it is unclear what costs and effects will be most relevant to decision makers
- you’re evaluating a complex digital product that has multiple effects – for example health and non-health benefits – that would be difficult to combine into a single measure
- the decision maker is particularly interested in the impact of your digital product on broader patient-oriented outcomes, such as patient wellbeing and satisfaction
Pros
Benefits of CCA include:
- it gives you a simple broken-down (disaggregated) summary of costs and effects of your digital product
- decision makers can choose the combination of costs and effects that are most relevant to their context, and apply their own weighting to the effects
- it can include a broader range of effects than other analyses, such as user experience and convenience of care
Cons
Drawbacks of CCA include:
- decisions made at the individual decision maker level may not always be in the best interest of patients or society
- CCA results may be less generalizable because the choice of relevant costs and effects and the weighting attached to them is often context-specific
- interpretation of the results tends to be more subjective than other forms of economic evaluation, and there is scope for cherry-picking positive results
How to carry out a cost consequence analysis
You should follow the general points for any economic evaluation study. There are also points that are particularly relevant to cost consequence analysis (CCA):
Choosing your study perspective
CCA often involves a comprehensive assessment of costs and effects under the broadest perspective possible. Then individual decision makers can choose the combination of costs and effects most relevant to their decision context according to their chosen perspective, which may be narrower than the CCA perspective.
Measuring costs and effects
CCA should capture as many relevant cost impacts of your digital product as practically possible. This may include:
- costs to the NHS
- costs to patients (for example, out-of-pocket fees, training, travel, productivity losses)
- costs to others (for example, informal care, social care costs)
CCA has the flexibility to report a broad range of effects to demonstrate value for money. The decision maker can then decide on their relative importance. They might be interested in:
- broader health effects – safety, adverse events, wellbeing
- non-health effects – user experience, satisfaction, empowerment, social inclusion
- non-patient effects – health system efficiency, caregiver outcomes
Reporting the results
Costs and effects should be reported in a simple and disaggregated format – that is, cost and effect components are reported separately. The level of disaggregation should be meaningful and allow the decision maker to understand the likely impact of your product across distinct dimensions of costs and effects.
Trade-offs between costs and effects are left to the decision maker, but you should still report incremental differences between your product and alternative options. This will help the decision maker understand how your product compares to competing alternatives for each individual cost and effect component.
Example: The ESTEEM study
Campbell and others (2014), Management of same-day consultation request in general practice (the ESTEEM trial): a cluster-randomised trial and cost-consequence analysis.
The ESTEEM study conducted a cluster-randomised controlled trial and a cost consequence analysis (CCA) of three different triage systems for managing same-day consultations in primary care:
- GP-led triage
- nurse-led triage
- usual consultation system
GP and nurse triage systems involved both clinical and IT training. Decision support computer software was developed to support the nurse-led triage.
The CCA’s aim was to assess the different costs and effects of alternative management systems for patients requesting same-day appointments in general practices. The study took the perspective of the healthcare system, so it excluded costs beyond those to the NHS and excluded non-health effects.
Resource use data was collected using within-trial data collection forms. Unit costs were taken mostly from Unit costs of Health and Social Care, and market prices (software and license fees).
The CCA considered a wide range of costs and effects associated with the new triage system, measured 28 days after randomisation:
Benefits
- increased healthcare contacts (GPs, out-of-hours primary care, walk-in centres)
- better patient experience (fewer difficulties with phone access, receiving prompt care, seeing a GP or nurse, getting medical help, and convenience of care)
- higher overall satisfaction score
- better problem resolution
- improved patient safety (less A&E attendance, ‘unplanned’ hospital admissions)
- greater health-related quality of life (EQ-5D-3L)
Costs
- intervention costs (set-up and delivery of triage systems)
- clinical and IT training (staff time spent in training events)
- software and equipment (computer decision support software and license fees)
- staff time used on the delivery of triage contact
- A&E admissions
The study reported a disaggregated summary of the costs alongside the effects in a table format. It did not attempt to combine the results into a single measure.
More information and resources
Mauskopf and others (1998), The role of cost-consequence analysis in healthcare decision-making [summary only; purchase required for full article]. This study provides a more comprehensive discussion of the advantages and disadvantages of CCA for informing healthcare decision making.
Webb and others (2019), A randomised control trial and cost-consequence analysis to examine the effects of a print-based intervention supported by internet tools on the physical activity of UK cancer survivors.