Cost Consequence Analysis

Cost consequence analysis (CCA) is a form of economic evaluation that presents the costs and multiple outcomes of two or more alternatives in a disaggregated format, listing each cost and consequence separately without combining them into a single summary ratio. Unlike cost effectiveness or cost utility analysis, which produce incremental ratios, CCA displays all the relevant inputs and outputs in a tabular format, allowing decision makers to weigh the components according to their own values and priorities. CCA is sometimes described as the most transparent form of economic evaluation because it makes all trade offs visible.

CCA is particularly useful when an intervention produces multiple outcomes that cannot easily be reduced to a single metric. A complex public health intervention might simultaneously reduce hospitalizations, improve quality of life, decrease caregiver burden, and increase patient satisfaction. Combining all of these into a single cost per QALY ratio may obscure important differences that matter to different stakeholders. CCA presents the full picture, empowering decision makers, whether they are clinicians, policymakers, patients, or funders, to assign their own weights to different outcomes. It is also valuable as a precursor to more formal economic evaluations, providing the data needed to construct cost effectiveness or cost utility ratios later.

Researchers measure the costs of each alternative, broken down into relevant categories (direct medical costs, direct nonmedical costs, indirect costs, and out of pocket costs). They then measure all important outcomes, which may span clinical endpoints, patient reported outcomes, process measures, and resource utilization. The results are presented in a summary table that lists each cost category and each outcome measure for each alternative side by side. No single summary statistic is calculated. Decision makers examine the table and draw their own conclusions about which alternative represents the best value, given their particular priorities and context. Some researchers supplement the table with narrative interpretation, but the defining feature of CCA is that the components remain separate.

CCA is appropriate when an intervention affects multiple outcomes that different stakeholders value differently. It is commonly used in evaluations of public health programs, integrated care models, and complex interventions where reducing outcomes to a single ratio would lose important information. CCA is also useful when there is no consensus on which outcome should serve as the denominator of a cost effectiveness ratio. Some health technology assessment agencies accept CCA alongside standard economic evaluations: the economic evaluation guidelines of Canada's Drug Agency (formerly CADTH), for example, treat a CCA as a complement to, not a substitute for, a cost utility analysis.

A frequent criticism is that CCA leaves too much interpretation to the reader, making it possible for different stakeholders to reach different conclusions from the same data. This is by design, but researchers should present the data clearly enough that the trade offs are evident. Another mistake is omitting important cost categories or outcomes, which undermines the comprehensiveness that is CCA's main advantage. Researchers sometimes present so many outcomes that the table becomes overwhelming; focusing on outcomes identified as important by stakeholders improves usability. Finally, failing to report confidence intervals or uncertainty ranges around costs and outcomes leaves decision makers unable to judge the precision of the estimates.

Researchers evaluate a community pharmacy medication review service for elderly patients with polypharmacy. The CCA table compares the intervention (pharmacist led review plus follow up) with usual care across six months. Direct costs: the intervention costs $120 more per patient. Outcomes: the intervention group has fewer adverse drug events (2.1 vs 4.8 per 10 patients), fewer emergency department visits (0.3 vs 0.7 per patient), modestly higher medication adherence (85% vs 78%), and similar patient satisfaction scores (8.2 vs 8.0 on a 10 point scale). The disaggregated presentation allows health system administrators focused on emergency department costs, clinicians focused on adverse events, and patients focused on adherence to each identify the dimensions most relevant to their decisions.