Journal of Nursing Scholarship Third Quarter 2002 277 Health Policy and Systems Economic Evidence for Evidence-Based Practice Patricia W. Stone, Christine R. Curran, Suzanne Bakken Purpose: To explicate (a) the types of economic analyses available to nurses, (b) the measurement of costs in different types of economic evaluations, (c) recommendations for standardization, and (d) the assessment of economic evaluations for evidence-based practice. Methods: Five types of economic analyses are reviewed. Recommendations for standardization of cost-effectiveness analyses are included as well as a worksheet for use in critiquing economic evaluations for validity and applicability to clinical settings. Findings: Limited knowledge and a lack of consistent approaches to economic analyses are evident in the nursing and health care literature. However, nurses have not contributed to the conduct of rigorous economic evaluations or research to the extent found in other health care disciplines. Conclusions: Basing nursing practice on the best available evidence is now the expected standard of care. Applying economic evidence to practice requires understanding the methods used to conduct economic evaluations and to analyze the rigor of such evaluations. JOURNAL OF NURSING SCHOLARSHIP, 2002; 34:3, 277-282. ©2002 SIGMA THETA TAU INTERNATIONAL. [Key words: cost-utility analysis, cost-effectiveness, quality-adjusted life years, evidence-based practice, economic evaluation] * * * Patricia W. Stone, RN, PhD, Alpha Zeta, Assistant Professor, School of Nursing; Christine R. Curran, RN, PhD, CNA, Alpha Zeta, Assistant Professor, Director, Informatics Program, Director, Research Resources; Suzanne Bakken, RN, DNSc, FAAN, Alpha Zeta, Alumni Professor of Nursing, Professor of Medical Informatics; all at Columbia University, New York. The authors are grateful to Dr. William Holzemer and colleagues for permission to cite their ongoing study. Correspondence to Dr. Stone, Columbia University, School of Nursing, 617 West 168th Street, New York, NY 10032. E-mail: ps2024@columbia.edu Accepted for publication May 8, 2002. B asing nursing practice on the best available evidence is now the expected standard of care. According to Sackett, Straus, Richardson, Rosenberg, and Haynes, (2000, p. 1), evidence-based practice is the “integration of best research evidence with clinical expertise and patient values.” But should “best practice” be done at all costs? Use of all effective clinical services can exceed available resources. Thus, nurses, as well as other clinicians, need evidence about the cost-effectiveness of care and how to measure economic value of interventions. Applying economic evidence to practice requires understanding of the methods used to assess the rigor of economic evaluations. Thus, the purpose of this article is to discuss the types of economic analyses available to nurses and the measurement of costs in economic evaluations. Recommendations for standardization of cost-effectiveness analyses are presented, as well as a worksheet for critiquing economic evaluations for validity and applicability to clinical settings. Types of Economic Evaluations The terminology used in economic appraisal of health care can be confusing. All economic analyses are fundamentally about choices. Measuring the cost of a new therapy, although useful information as part of an economic analysis, is merely an exercise in accounting, not economics. To have a valid economic analysis, one needs to compare one or more alternative courses of action. Five different analytic tools are commonly used in assessing the economic effects of new health care interventions or technology (see Table 1). In all these economic outcome evaluations, alternative strategies are compared, and the incremental costs of the competing strategies are computed. The methods differ only in how effects (outcomes) are measured. In the following section, each method will be briefly described, examples from nursing and health care literature will be provided, and the methods will be illustrated using the following clinical research example. Holzemer and colleagues (Holzemer, Henry, Portillo, & Miramontes, 2000) developed the Client Adherence Profiling- Intervention Tailoring (CAP-IT), a structured nursing intervention aimed at enhancing adherence to HIV/AIDS medications. This new intervention is being compared to usual care in the ambulatory setting in a randomized