Abstract
The scientific progress in neuro-prostheses during the last ten years has led to a number of clinical applications that are being introduced in the health care system. Whereas the research so far has been carried out in the biomedical research environment it now enters the clinical area. This clinical research leads to new challenges concerned with clinical effectiveness, decisions on prescription to patients and economic value. In relation to the latter it is important to realize that health care budgets are under pressure world wide. For instance, in the Netherlands and the USA health care expenses are estimated to be US$27,8 billion (2000) and US$1149 billion (1998) respectively. It is expected that health care growth in the Netherlands will be about 6% of which approximately 75% will be caused by technological advances. From this point of view it is not surprising that, in addition to clinical evaluation, cost-effectiveness research increasingly receives attention. This paper gives an overview of the principles and methodology of economic evaluation, the role of economic modeling and the challenge of assessing outcomes in economic appraisals. It is concluded that it is worthwhile to include economic evaluations in earlier stages of technology introduction. From a methodological point of view it is concluded that outcome measurement is especially important, since one has to show the relative gain of the neuro-prosthesis while a reduction in costs is not very likely. Outcome assessment and valuation can typically be performed using approaches like multi-attribute utility instruments, direct utility assessment (standard gamble), contingent valuation or choice modeling experiments. Each of the methods will be discussed. Finally, some conclusions will be drawn regarding economic evaluations in general and directions for the future.