Cost effective analysis in health economics. The This recommendation statement from the Second Panel on Cost-Effectiveness in Health and Medicine reviews methodological advances in cost-effective analyses and updates the 1996 recommendations for the conduct and report of cost-effective analyses. 1 What is economic appraisal? Cost-effectiveness analysis (CEA) is the main way that economic evaluations are carried out in the health care field. Cost-Benefit Analysis (CBA) is the economic evaluation method that should be used to help decide what to invest in when the objective is to Sep 17, 2024 · Different methods of economic evaluation can help you answer different questions: Program Cost Analysis: What is the cost of the program or intervention? Cost of Illness: What is the economic burden of the condition? Cost-Effectiveness Analysis: How do costs compare to outcomes? Cost-Benefit Analysis: How do costs compare to benefits? In general, the Center for Health Impact Evaluation will recommend evaluations using cost-effectiveness analysis (or, when appropriate, another type of study such as Health Impact Assessments). Economic evaluations, including cost-effectiveness analyses, are frameworks for decision-making. lives saved per £ spent). The costs associated with the intervention are measured in monetary units (dollars); the evaluation types differ with respect to how outcomes are measured. Online courses are held via Zoom (live sessions only, no recordings). Sep 20, 2024 · Both CBA and cost-effectiveness analysis (CEA) include health outcomes. May 23, 2025 · Learn about the principles, theories, methods, models, and applications of cost-effectiveness analysis in health economics, as well as the software and tools used and how data analysis is applied. In contrast, cost-effectiveness analysis looks at evidence for entire patient populations, comparing the health benefits and economic costs of different treatment options. It focuses solely on cost-effectiveness analysis in health care. The PICOT framework can be used to understand and interpret cost-effectiveness research. This gap calls for approaches that can quantify the impact of intervention of Feb 1, 1997 · Abstract To address controversies in the application of cost-effectiveness analysis, we investigate the principles underlying the technique and discuss the implications for the evaluation of medical interventions. 1 By doing health economic analysis, we can obtain incremental cost-outcome ratios, the relation of the estimated additional costs, and the estimated additional outcomes saved or lost using alternative healthcare I. A cost‐effectiveness analysis is one type of analysis undertaken in health economic evaluation . Jul 18, 2025 · If the drug is found to be cost-effective, it may be recommended for use in the healthcare system. 4 Cost-effectiveness analysis Outcomes in CEA are expressed in natural units or physical units of effect that This online course is designed for health economists and health professionals with a background in health economics who want to learn how to conduct cost-effectiveness analysis using the statistical software for data science Stata. The third volume in the Handbooks in Health Economic Evaluation series, this book provides the reader with a comprehensive set of instructions and examples of how to perform an economic evaluation of a health intervention. Apr 16, 2025 · Health equity is a growing concern for policymakers across the globe. Sep 3, 2007 · First the article will present a short overview of cost effectiveness, along with a discussion of two cost effective measures, cost-effective analysis and cost-utility analysis. Collectively funded health systems in particular usually seek to maximize health outcomes through the provision of health service inputs. Both involve comparing the incremental costs and benefits of alternative interventions. To address controversies in the applications of cost-effectiveness analysis, we investigate the principles underlying the technique and discuss the implications for the evaluation of medical interventions. It is a crucial concept in economics, healthcare, public policy, and business decision-making, emphasizing the importance of obtaining the maximum benefit from limited resources. Cost-benefit analysis is defined as an economic evaluation that values consequences in monetary terms, allowing for the comparison of community intervention costs with the net worth of treatment alternatives by estimating benefits minus costs. In other words, moving resources from cost-ineffective interventions to cost-effective ones could enhance the allocative efficiency of the health sector. Canadian and UK health economists question the economic foundations of such an approach Who could resist implementing the results of a study showing that using alteplase (tPA; tissue Comparison of Approaches to Measuring Cost Impact: Cost Benefit, Cost-Effectiveness, and Cost-Utility Analyses Cost-benefit, cost-effectiveness, and cost-utility analyses are part of a group of methods that measure the efficiency of interventions and achieving desired outcomes. Cost Utility The cost-utility analysis also considers healthcare costs and health effects, but the effectiveness measure attempts to value the consequences of the health outcomes by adjusting the outcomes by health state preference scores or utility weights. Cost-effectiveness analysis is distinct from cost–benefit analysis, which assigns a monetary value to the measure of effect. In contrast, cost-effectiveness analyses measure the health consequences of the health intervention in a single natural unit (such as life-years gained, cases averted, or cases detected), and cost-utility analyses (a specific type of cost-effectiveness analysis) measure the health consequences using a generic measure of health status that Health economics produces estimates of disease burden, costs, and cost-effectiveness which help policymakers prioritize diseases to target As discussed in the benefit-cost analysis module, economic evaluations are best conducted once a program, policy, or intervention has proven effective but prior to widespread implementation and dissemination. Think of duplicating the intervention: Community health care workers included in programme, but volunteer their time Jan 1, 2025 · Cost-effectiveness analysis is a well-established health economic tool to assess the clinical and economic value of new health technologies. Cost-effectiveness analysis (CEA) is defined as a complex valuation that assesses both health outcomes and economic benefits of a specific aspect of clinical care over a designated time frame. 1 As the definition suggests, any CEA would comprise two measurements – costs and consequences, which has to be carried out for both the 6. However, CEA has limited validity in deciding whether any health care evaluation is socially worthwhile and hence justifies Economic Evaluation (EE) or cost-effectiveness analysis (CEA) is one of the important aspects of a health technology assessment. In cost-effectiveness analysis, to be discussed in module 5, program costs are in dollars but benefits are left in some natural unit, such as life years saved. Jul 23, 2020 · Background and Aim: Economic evaluation, through comparing the costs and benefits of the health interventions, helps policy makers and managers to use cost-effective interventions and consequently Oct 15, 2021 · World Health Organization Choosing Interventions that are Cost-Effective (WHO-CHOICE) has been a global leader in the field of economic evaluation, specifically cost-effectiveness analysis, for almost 20 years. A cost-effectiveness analysis has become an important method to inform allocation decisions and reimbursement of new technologies in healthcare. It compares an intervention to another intervention (or the status quo) by estimating how much it costs to gain a unit of a health outcome, like a life year gained or a death prevented. Cost-effectiveness analyses are used by various stakeholders for such purposes because health care resources and financing may be scarce, d … Jul 26, 2025 · Introduction Economic evaluations are helpful for efficient resource use. As decisions regarding public health policy, insurance reimbursement, and patient care incorporate factors other than traditional outcomes such as satisfaction or symptom resolution IntroductIon Health economic analyses are comparative analysis of healthcare technologies or health strategies and their alternative options in terms of their costs and consequences. World Scientific Publishing Co Pte Ltd Sep 27, 2018 · Cost Benefit Analysis (CBA) and Cost Effectiveness Analysis (CEA) are the economic evaluation techniques which are used to evaluate two or more interventions. It compares two or more health technologies by measuring the additional costs and the additional consequences of each alternative, and dividing the incremental costs by the incremental outcomes. Apr 18, 2023 · A cost-effectiveness analysis has become an important method to inform allocation decisions and reimbursement of new technologies in healthcare. DALYs) Health Economics: 5 - Techniques of Economic Appraisal 5. We also outline ongoing issues and considerations related to perspectives that are important to be aware of when comparing and interpreting economic evaluations. Some types of analysis only examine the costs of an intervention or a disease (e. Pharmacoeconomics is a branch of health economics that usually focuses on balancing the costs and benefits of an intervention towards the use of limited resources, aiming at maximizing value to patients, healthcare payers and society through data driven decision making. Oct 23, 2023 · In addition, everyone does intuitive cost-effectiveness analyses in their daily lives. Jul 17, 2017 · Cost Effective Analysis (CEA) In this method of analysis, cost is measured against the effectiveness of the intervention (effectiveness is the final consequence) The consequences of the comparing interventions may vary here (different than cost minimization analysis where the outcomes of interventions were identical). Measurement of efficiency in such systems is important in determining whether resources are The $50,000 threshold is the most commonly cited cost-per-QALY threshold in U. AI generated definition based on: Clinics in Podiatric Medicine and Surgery, 2024 The competitive worldwide economic environment and ever-increasing costs of health care have created a setting in which understanding costs and making sure that we achieve good value in health care are paramount. In principle, the threshold ought to reflect opportunity costs of reimbursing a new technology. Cost–effectiveness analysis: an overview of its strengths and weaknesses Countries all over the world place a high priority on the health of their people. Cost-Effectiveness Analysis in Medicine and Public Health Winter 2025 (2 units) In a world where policy-makers, donors, and payers are increasingly cost-sensitive, how does one measure returns on investments in health? Cost-effectiveness analyses can help formally evaluate clinical and policy decisions, particularly when, as is usually the case, decisions have to be made with incomplete or Key principles of cost-effectiveness analysis and Budget Impact Analysis. May 14, 2024 · This article aims to outline and introduce the main types of perspectives used in economic evaluations, as well as to discuss their implications on cost-effectiveness calculations. The discipline of cost-effectiveness (CE) analysis has developed over several decades as a tool for objectively assessing the value of new medical strategies, by simultaneously examining incremental health benefits in light of incremental costs. Keywords: Cost effectiveness, Cost-effectiveness analysis, Cost-utility analysis, Economic evaluation, Health care economics, Health economics Cost-effectiveness analysis (CEA) is a form of economic analysis that compares the relative costs and outcomes (effects) of different courses of action. The Dec 15, 2022 · The aim of this paper to demystify the working parts of a health economic evaluation, and explain to clinicians and clinical researchers how to read and interpret cost-effectiveness research. This paper aims to clarify the relationship between economic evaluation methods and two types of health care efficiency, aiding implementation scientists in selecting the appropriate approach for their research. Obtaining accurate cost data is often difficult and can limit the generalizability of a study. Cost-effectiveness analysis is a way to understand the value of a health care intervention in terms of assessing the money spent to produce beneficial outcomes. In developed nations, health care spending is an increasingly important economic and political issue. Projects should be ranked from highest to lowest EC ratios. Although this science is now several decades old, it has been refined over the last several years This includes work on Generalized Cost-Effectiveness Analysis, WHO-CHOICE, the UHC Compendium, and the global survey on HTA and Health Benefit Packages. Designed by faculty from the Department of Health Policy at LSE, this technical course will teach you to conceptualise a model, inform resource allocation decisions, and analyse a cost-effectiveness study. Unlike cost-effectiveness analysis, which measures health outcomes relative to costs, CBA assigns a financial value to health benefits. The principles are: Cost-effectiveness analysis remains a flourishing and evolving field with many opportunities for research. Sep 20, 2024 · What is cost-effectiveness analysis? Cost-effectiveness analysis (CEA) is a way to examine both the costs and health outcomes of one or more interventions. One approach to seeking value is through the use of cost-effectiveness analysis. A cost-effectiveness analysis requires a threshold to which the cost effectiveness of a new intervention can be compared. Using a standard von Neumann-Morgenstern utility framework, we show how a cost-effectiveness c … A minimal cost-effectiveness decision tree analysis package. S. They help to illustrate tradeoffs between selecting one choice over another. The use of a consistent methodology across disease areas is a major added value of the CHOICE approach, as it allows for fair comparison between and across health programmes. The result of a cost‐effectiveness analysis is the incremental cost‐effectiveness ratio. For example, work in health economics looking at the cost-effectiveness of different treatments. Cost-effectiveness analyses are used by various stakeholders for such purposes because health care resources and financing may be scarce, depending on the economy, and certain interventions may be costly to produce such outcomes His research focuses on understanding the economic value of health care through applied economic theory, comparative and cost-effectiveness analyses, causal inference methods, program evaluation, and outcomes research. When planning an Sep 17, 2022 · The Markov model in pharmacoeconomics is used to estimate the cost-effectiveness of treatment programmes (prevention, hospital care, etc). Cost-effectiveness analysis compares the costs and health outcomes of two or more competing interventions for a given health condition. , donated goods, and volunteered time). , cost of illness studies) independently, whereas other types of analysis evaluate both the costs and consequences of an intervention Sep 1, 2017 · Economic evaluation using cost-effectiveness analysis (CEA) technique helps the analyst to identify the most cost-effective option for achieving a pre-set objective. Deaths averted provides a measure of health gain but CEAs typically use measures that take account of both years and quality of life gained. […] Cost-effectiveness analysis takes an additional step of directly addressing the potential trade-offs of added costs and improved health outcomes and allows decision makers to evaluate the allocation of resources by characterizing the cost of health interventions per added unit of benefit. cost-effectiveness studies, though increasingly researchers are referencing a $100,000 threshold (Neumann et al. Economic evaluation in health care What is economic evaluation? To evaluate the value of health Why conduct economic evaluation? To determine cost-effectiveness of health care interventions/services To assist decision-making in choosing to fund specific health care interventions Prioritisation of limited resources to maximise health gains Sep 16, 2024 · In an era of rising healthcare costs and limited resources, cost-effectiveness analysis (CEA) has emerged as a critical tool for decision-makers in the healthcare sector. The choice of perspective and included cost The Role of CEA in Healthcare Decision Making Cost-effectiveness analysis (CEA) plays a crucial role in healthcare decision-making within various sectors, such as hospitals, healthcare providers, and government agencies. Health-care decisions are complex; they require synthesis of a myriad of data variables and sources, and the impact of the choices made is Feb 29, 2016 · Comprehensive analysis skills are essential for students seeking careers in public health, medicine, biomedical research, health economics, health policy, and more. Cost-effectiveness analysis (CEA), by relating an intervention’s cost to its effectiveness (in terms of some change in health) as a ratio, is thus a standard approach to measuring the net value of a health care intervention. It serves as an essential tool for evaluating interventions and determining their cost-effectiveness in achieving specific outcomes. Conventional cost-effectiveness analysis (CEA), commonly used in evaluating health interventions, primarily focuses on the average and aggregate health outcomes in the targeted population, neglecting the distributional impacts on health equity. The methodology of economic evaluations in healthcare is multifaceted, incorporating several key components that ensure the accuracy and relevance of the analysis (Sharma et al. Cost-effectiveness analyses are used by various stakeholders for such purposes because health care resources and financing may be scarce, depending on the economy, and certain interventions may be costly to produce such outcomes The keywords used for the literature search were MeSH terms and other words such as economic evaluation, cost-benefit analysis, cost-utility analysis, cost-effectiveness analysis, and health. Nov 30, 2012 · 7 Assessing cost effectiveness Health economics is about improving the health of the population through the efficient use of resources, so it necessarily applies at all levels, including individual clinical decisions. Methods We clarify the connection between cost-effectiveness analysis (CEA) and allocative efficiency, and Generalized Cost-Effectiveness Analysis (GCEA) Approach The use of cost-effectiveness analysis within health decision making processes is increasingly common. It can express results in terms of net benefit or loss, or as a ratio of benefits to costs. A cost-effectiveness analysis requires a threshold to which the cost effectiveness of a new intervention Techniques of economic appraisal (including cost-effectiveness analysis and modelling, cost-utility analysis, option appraisal and cost-benefit analysis, the measurement of health benefits in terms of QALYs and related measures e. Aug 25, 2021 · Differences in the Main Types of Health Economic Analyses Used for Evaluating Resource Allocation Decisions There are many different approaches used for health economic analyses. Oct 15, 2014 · Results: Cost-benefit, cost-effectiveness, and cost-utility studies all integrate cost and outcome data into a decision analysis model. • Module 1: Introduction to Health Economics • Module 2: Identifying, Measuring, Valuing and Analysing Costs • Module 3: Identifying, Measuring, Valuing and Analysing Outcome • Module 4: Policy Use and Interpretation of Cost-effectiveness Analysis • Group exercise: Application of Economic Evaluation Methods 65 years What is economics? Cost-Effectiveness, the QALY, and the evLY Clinicians play a vital role in helping individual patients decide what treatment is best for them. The growing demand for high-quality healthcare services, coupled with financial constraints, necessitates the careful allocation of resources to maximize health outcomes. 2. In economic evaluation of healthcare interventions, the dominant practice is to calculate an incremental cost effectiveness ratio, usually based on the comparison of a new intervention against current practice. . However, CBA places a monetary value on health outcomes so that both costs and benefits are in monetary units (such as dollars). In benefit-cost analysis, which will be discussed in module 4, program costs and benefits are converted into dollars. [1] Cost-effectiveness analysis is often used in the field of health services, where it may be inappropriate to May 15, 2023 · For example, economic costs should be used within economic evaluations of healthcare interventions (such as cost-effectiveness analysis or cost–benefit analysis). Oct 29, 2021 · In particular, the novelty of this research is confirmed by the absence of bibliometric research focused on the theme of cost-effectiveness and thematic related to health, in a broad way. In routine medical care, health economic assessment becomes increasingly important due to progressively limited resources, rising demands, population increases, and continuous therapeutic innovations. Mar 26, 2019 · Cost-effectiveness analysis (CEA) is a type of economic evaluation that compares the costs and outcomes of two or more interventions with a common health outcome but different effectiveness 6,7. Jan 1, 2009 · The competitive worldwide economic environment and ever-increasing costs of health care have created a setting in which understanding costs and making sure that we achieve good value in health care are paramount. Using a standard von Neumann-Morgenstern utility framework, we show how a cost-effectiveness criterion can be derived to guide resource allocation decisions, and how it varies with The $50,000 threshold is the most commonly cited cost-per-QALY threshold in U. , 2014). These types analyses can help organizations analyze the value of an intervention or program relative to its cost Oct 3, 2024 · Conclusion Cost-Benefit Analysis is an indispensable tool in health economics, providing a structured framework for evaluating the economic efficiency of healthcare interventions. Dec 1, 2021 · Cost-effectiveness analysis is a way to understand the value of a health care intervention in terms of assessing the money spent to produce beneficial outcomes. These different types of studies are distinguished mainly by the way in which outcomes are valued. The data from CEA can be used in multiple ways: during doctor-patient shared clinical decision making, in the development of health policy, or in the design of health systems for care delivery. Apr 23, 2025 · What is Cost-Benefit Analysis in Healthcare? Cost-benefit analysis (CBA) in healthcare is a method used to evaluate the economic impact of medical interventions by comparing costs and benefits in monetary terms. Abstract Economic evaluations in the healthcare are used to assess economic efficiency of pharmaceuticals and medical interventions such as diagnoses and medical procedures. Background Practice guidelines for cost-effectiveness analysis (CEAs) emphasize the importance of the analytic perspective assumed in the analysis because it determines which costs and benefits are included [1 – 4]. FORMAT This is an intensive online course for health economists and health professionals, with some knowledge of health economics who wish to learn about the methodology of cost-effectiveness analysis as applied in health care. Two examples of this are Oct 9, 2021 · Cost-effectiveness analysis is a way to understand the value of a health care intervention in terms of assessing the money spent to produce beneficial outcomes. This form of analysis is of great power and value to the health-care system. , 2021). More work is needed on many fronts to understand how best to incorporate CEA into policy and practice. This study introduces the main concepts of economic evaluation across its key steps: planning, outcome and cost calculation, modeling, cost-effectiveness results, uncertainty analysis, and decision-making. 10, 11 However, CUA has the attraction of providing a comprehensive and standardized framework for comparing costs and outcomes across disparate programmes or interventions and patient populations. 63–66 Utilities attempt to aggregate the morbidity and mortality effects of an intervention into a single measure, usually a quality What is health economics? Health economics: marginal analysis Usually health economics evaluates costs and consequences of (small) change in health care interventions or the incremental costs and benefits between different options Marginal cost: is the incremental cost of one extra unit of a healthcare intervention Dec 6, 2022 · This area of work in WHO covers both technical and allocative efficiency: Costing and budget impact, global price tags and investment cases, cost-effectiveness analysis and health technology assessment, benefit package design and priority setting and resource allocation. However, a series of methodological shortcomings may limit the practical application of cost-effectiveness analysis results for deciding to reallocate resources between interventions to achieve social objectives. This makes it a powerful tool for decision The second equation is the effectiveness per unit of cost (e. In other words, when conducted evaluations on a comparative scale using clinical indicators, such as a cost-effectiveness analysis or a cost-minimization analysis, it is also important to conduct evaluations on an absolute scale using benefit as the outcome so that we can discuss the state of social resources (such as the scale of health Apr 7, 2024 · Published Apr 7, 2024Definition of Cost-Effectiveness Cost-effectiveness refers to the evaluation of the relative expenditure (costs) and outcomes (effects) of two or more courses of action. Understanding these components is crucial for interpreting the results of an evaluation and for designing studies that accurately assess the value of healthcare interventions. Classically, CEA is defined as a comparative assessment of two or more interventions, in terms of their costs and consequences. Designed specifically for building and running decision trees with several helper functions and simple interfaces. Conclusion Health economics is a vital component of clinical research, providing a framework for evaluating the cost-effectiveness of healthcare interventions. This primer distils key content and constructs of economic evaluation studies, and explains health economic evaluation in plain language. The book is developed out of 'Applied Methods of Cost-effectiveness Analysis' the three day course taught by the authors and other members of the Health Economics Research Centre in Oxford. AI generated definition based on: Clinics in Podiatric Medicine and Surgery, 2024 Cost-Effectiveness Analysis (CEA): A comparative method that evaluates the costs and health outcomes of different interventions to determine which provide the best value. The criteria for judging cost-effectiveness are different in different healthcare systems and in different countries. The perspective may reflect a patient, a specific payer (public or private), the entire healthcare sector, or all of society. A recent This article aims to explore overlaps and differences between the emerging concept of value-based healthcare (VBHC) and the established field of cost-effectiveness analysis (CEA), as well as the feasibility of integrating them together. tions to improve population health. Cost-effectiveness analysis is one of several types of economic evaluation that can be useful in choosing among alternatives for health care delivery. To provide clinicians with a basic understanding of economic studies, including cost-benefit, cost-effectiveness, and cost-utility analyses. The role of health economic evaluations in clinical research, pricing & reimbursement decisions, and post-launch. Economic evaluations enable comparisons of both the costs and effects of an intervention. It also has wide application in applied fields: economics, logistics, marketing. Summary of Background Data. g. 1 Interest in the promise of enhancing allocative efficiency of health systems has led to analytical efforts to study the cost-effectiveness of a broad range The Modelling Cost-Effectiveness in Healthcare online certificate course will equip you with the tools to design, analyse, and interpret cost-effectiveness models in your context. How do cost-effectiveness analysis and benefit-cost analysis differ? Cost-effectiveness analysis and benefit-cost analysis are both forms of economic evaluation that inform public health decisions within and outside of the health care system. Sep 1, 2009 · Abstract Cost-effectiveness analyses (or CEAs) in health describe interventions in terms of their cost per unit of health gain that they provide. There are four main types: cost-minimization, cost effectiveness,cost-utility, and cost-benefit. Cost-Effectiveness Analysis in Health walks you through the process from a real-world perspective to help you build a skillset that's immediately applicable in the field. The outputs to be ranked by cost-effectiveness analysis are often social or environmental in nature. , 2021; Turner et al. Objective. Economic costs Economic costs reflect opportunity costs of an input or resource, and not merely costs in the strict financial sense – includes the estimated value of goods and services for which there were no financial transactions (e. In this video, we take a simplified look at what health economic evaluation is, and explain the four main types: cost-minimisation analysis, cost-effectiveness analysis, cost-utility analysis, and Mar 6, 2023 · Cost-effectiveness analysis (CEA) is the main way that economic evaluations are carried out in the health care field. A special type of cost-effectiveness analysis—called cost-utility analysis—includes only health outcomes. In this way, economic evaluations are typically conducted retrospectively. who is this course for? The course i s designed for those who need to perform cost-effectiveness Cost-effectiveness analysis (CEA) is defined as a systematic approach used in health economics to evaluate the costs and effectiveness of competing medical treatments, aiding in informed healthcare decision-making. The Markov model in health economics generalizes a patient flow process. It integrates broad medical evidence, patient effects, and associated costs at various levels, including patient, payer, or societal. Cost-effectiveness analysis (CEA) is defined as a systematic approach used in health economics to evaluate the costs and effectiveness of at least two competing healthcare strategies, aiding in medical decision-making. It focuses solely on cost-effectiveness analysis in healthcare. However, CEA has limited validity in deciding whether any health care evaluation is socially worthwhile and hence justifies funding. In this paper, we contrast the Jan 3, 2024 · In the healthcare setting, CUA and CEA are recommended by regulatory bodies worldwide. Study Design. Then the measurement of quality-adjusted life-years and disability-adjusted life years will be presented. Course Description This course is intended to give students an overview of the theory and applications of cost-benefit analysis, cost-effectiveness analysis, cost-utility analysis and related forms of economic evaluation for interventions in the health care sector. Cost-effectiveness analysis provides a systematic This study examines what study authors consider to be appropriate cost-effectiveness analysis thresholds as reflected in the referenced thresholds in their published cost-effectiveness analyses. Narrative overview. Economic evaluation is the comparative analysis of at least two health care interventions or alternatives in terms of both their costs and consequences. njt jqkn bw fx09h5 e4m8cj o6r v7 mznjw j7l waxecc