Mauskopf JA. Prevalence-based versus incidence-based economic evaluations for the assessment of new health care interventions. Value Health. 2012 Jun 1;15(4):A170.

OBJECTIVES: To compare the usefulness to decision makers of prevalence-based versus incidence-based economic evaluations of new health care interventions

METHODS: Comparison of evaluation methods by: population included, time horizon, outcomes measured, adherence to economic principles, and usefulness to decision makers.

RESULTS: An incidence-based economic evaluation follows a disease cohort for the duration of the disease and estimates discounted costs and health gains with alternative interventions. The cost-effectiveness ratio is based on individual utility maximization and provides information to decision makers about the efficiency of a new healthcare intervention compared to societal willingness to pay for health gains. It does not estimate annual budget impacts. It generally does not capture indirect effects on the population. A prevalence-based economic evaluation provides estimates of costs and health benefits for the total population for one year or cumulated over a longer time horizon. The estimated ratio of cumulative costs and health benefits is not based on economic principles. Appropriate threshold values for these ratios are those based on a percentage of Gross Domestic Product as recommended by the World Health Organization. The prevalence-based cost-effectiveness ratio provides information to decision makers on the affordability of the intervention and the value for money over the selected time horizon. A prevalence-based analysis can take into account indirect effects of health care interventions and is, therefore, frequently used for economic evaluations of vaccine programs.

CONCLUSIONS: Prevalence-based economic evaluations might be of greater use to health care decision makers than incidence-based evaluations because, in addition to estimates of value for money, they provide estimates of affordability and allow comparison of all types of health care interventions. Threshold values based on economic principles, however, are not applicable for ratios generated using the prevalence-based approach.

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