The evaluation and interpretation of an economic analysis will often differ substantially depending on the perspective from which it was undertaken, e.g., the patient or family, a health care provider or institution, a third-party payor, or society as a whole. Indirect and intangible costs, although very important to the patient and family, may not be considered in economic analyses from most other perspectives. The analysis of economic outcomes is frequently complicated by the multiple outcomes, skewed distributions, and frequent missing data. In addition, marginal summary measures do not necessarily reflect the absolute benefit or cost of an intervention. A strategy associated with a lower absolute effectiveness may actually appear superior in terms of cost effectiveness or cost utility. It is important, therefore, to measure both the absolute as well as the marginal benefit and cost in such analyses. Nevertheless, when one is faced with new and costly technologies and limited health care resources, economic analyses can be critical to rational clinical and public health decision making. Economic analyses are perhaps most valuable when conducted in association with large randomized clinical trials (RCTs) in which tradeoffs exist between clinical benefit and economic impact
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