Table 1.
Parameters for analysis of the costs and effectiveness of CAM in oncology as discussed or used in the literature
| Type of analysis | Description | Parameters for costs | Arguments and questions to consider using these parameters |
|---|---|---|---|
| General consideration How relevant are data from study populations for the individual patient? Because CAM focuses on the needs of the individual patient, should the relevance of the data from studies be questioned? |
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| Cost analysis and cost-cost analysis | Direct costs of therapy1, 7 | Practitioner fees Diagnostic costs Therapy costs Service costs Facilities and equipment Ancillary staff Transportation Time off work (patient and relatives) Time Costs may vary with time in case of longer periods, discount rates have to be regarded Places Costs may be variable in different places Costs are different between countries Cost perspective Overall cost perspective or diagnosis of specific perspectives?5 |
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| Indirect costs1 | Provisions of the treatment facility for a method that is not part of regular health care Out-of-pocket costs to the patient Private costs Equipment purchase costs Productivity loss (patient and relatives) Time spent by the patient or relatives (including traveling and waiting) Other costs for society (pension, home care, care for minor children, or resources spent as manpower by professionals) Costs for caregivers Costs due to treatment failures |
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| Intangible costs1 | Pain Suffering Grief Adherence |
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| Cost-benefit analysis | Assigning a monetary value to the benefit (effect) of a treatment | Benefit in terms of Survival time Quality of life Allows for comparison of different treatment modalities and between different patient groups1, 3, 7 For costs, see previous page |
How and by whom is the benefit defined and measured? A monetary value for benefits may be difficult to define and consent (e.g. life) Most CAM methods address a broad range of treatment aims at the same time in the same individual Other benefits, such as ‘wholeness’ and ‘well-being’, are often discussed for CAM Examples of intangible benefits or humanistic outcomes1, 2 Sense of safety Physical comfort Enjoyment Meaningful activity Relationships Functional competence Dignity Privacy Individuality Autonomy Spiritual well-being Instruments from conventional medicine may not be adequate to measure the benefits and outcomes of CAM treatments |
| Cost-effectiveness and cost-utility analysis | Effectiveness | Effectiveness helps to compare alternative treatments in the same situation Direct comparability between different treatments with respect to the health-related outcomes1, 3, 7 For costs, see previous page Incremental cost-effectiveness analysis (ICER): ratio of the difference between costs and the difference between effectiveness between two treatments6 |
Choice of comparative treatment How should comparative treatment be determined? (Conventional method, CAM methods with similar goals or with a similar approach, or method with a similar amount of evidence?) How and by whom is effectiveness defined and measured? Is the concept of effectiveness different in CAM? |
| Utility | Allows one to compare treatments with different integrating outcomes and consequences, e.g. QoL measured in units and QALY1, 3, 4, 7 Utility may be measured using a visual analogue scale, time trade-off, and standard gamble For costs, see previous page |
Defining utility is highly subjective Often healthy subjects are used for these judgments Using healthy subjects for ratings does not take into account that patients with a life-threatening disease may judge the situation completely differently Healthy people may not be able to perceive the benefits of holistic care |
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