# Situation: The provincial health office asks public health nurses to help plan health education programs for its municipalities for the next three years. To compare two smoking-cessation education programs, the office divides each program's total cost by the number of years of life it adds, with each year weighted by the quality of health the person has during that year. Which type of economic evaluation is this?

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## 문제

Situation: The provincial health office asks public health nurses to help plan health education programs for its municipalities for the next three years.

To compare two smoking-cessation education programs, the office divides each program's total cost by the number of years of life it adds, with each year weighted by the quality of health the person has during that year. Which type of economic evaluation is this?

## 보기

1. Cost-effectiveness analysis
2. Cost-minimization analysis
3. Cost-utility analysis **✔ 정답**
4. Cost-benefit analysis

**정답: 3**

## 해설

Years of life weighted by the quality of health are quality-adjusted life years (QALYs), and cost per QALY gained is the unit of cost-utility analysis. Cost-effectiveness analysis expresses cost per natural unit, such as cost per smoker who quits or per life-year gained without quality weighting. Cost-benefit analysis converts both costs and benefits into money, and cost-minimization analysis compares only costs when the outcomes are known to be equal. Some texts treat cost-utility analysis as a special form of cost-effectiveness analysis; when both are offered, an outcome weighted by quality of life identifies cost-utility analysis.

## 심화 해설

Core concept

The question describes dividing each program’s total cost by the number of years of life it adds, with each year adjusted for the quality of health during that year. That adjusted unit is the quality-adjusted life year (QALY). When an economic evaluation uses cost per QALY gained as its outcome measure, it is a cost-utility analysis.

Why the other options do not fit

A cost-effectiveness analysis also reports cost per life-year gained, but it uses natural units without quality weighting—for example, cost per smoker who quits or cost per unadjusted life-year saved. The key difference in this scenario is the explicit quality-of-life weighting, which moves the evaluation into the utility framework.

A cost-benefit analysis converts both costs and health outcomes into monetary terms, such as dollars, and then compares them directly. No monetary conversion of health outcomes is described here.

A cost-minimization analysis is used only when the outcomes of two or more interventions are already known to be equivalent, so the analysis focuses solely on comparing costs. The scenario does not state that the two smoking-cessation programs produce identical outcomes.

How QALYs connect to the evidence

The QALY concept appears throughout the provided sources as the standard outcome for utility-based economic evaluations. In a systematic review and cost-utility analysis of pneumothorax management, the authors explicitly used QALYs to compare observation, aspiration, and chest tube placement, because each strategy affects both survival and the patient’s experienced health state [1]. The glioma review similarly notes that QALYs express treatment effects and are built from health utilities, which reflect the patient’s quality of life after an intervention [2]. A randomized controlled study in diabetic foot ulcer patients measured QALYs as the primary economic outcome to capture the impact of pharmaceutical care on both length and quality of life [3]. A Canadian cost-utility analysis of hepatitis D screening also used QALYs as the effectiveness measure over a lifetime horizon [4].

Key point! The defining feature of a cost-utility analysis is not simply that it measures life-years, but that it weights those life-years by health-related quality of life. When a question mentions “quality of health” or “quality-adjusted” life-years, the correct economic evaluation type is cost-utility analysis.

Watch out! Some textbooks describe cost-utility analysis as a subtype of cost-effectiveness analysis. On a licensure examination, when both options appear, the presence of quality-of-life weighting should direct the answer to cost-utility analysis rather than the broader cost-effectiveness category.

| Evaluation type | Outcome unit | Quality weighting | Example |
| --- | --- | --- | --- |
| Cost-utility analysis | Cost per QALY gained | Yes | Cost per quality-adjusted life-year from smoking cessation |
| Cost-effectiveness analysis | Cost per natural unit | No | Cost per smoker who quits, cost per life-year saved |
| Cost-benefit analysis | Monetary net benefit | Not applicable | Dollar value of health gains minus program cost |
| Cost-minimization analysis | Cost only | Not applicable | Comparing two programs with proven equal quit rates |

The scenario’s phrase “each year weighted by the quality of health the person has during that year” is the operational definition of a QALY. Because the office is calculating cost per QALY, the evaluation is a cost-utility analysis, which is the most precise and correct classification among the options [1][2][3][4].References (research sources)

- [1]Observation, Aspiration, or Tube Thoracostomy for Primary Spontaneous Pneumothorax: A Systematic Review, Meta-Analysis, and Cost-Utility Analysis.Meta-analysis/systematic reviewEamer G, Povolo CA, Petropoulos JA, Ohinmaa A, Vanhouwelingen L (2023) · DOI: 10.1016/j.chest.2023.05.017

- [2]Quality-adjusted life years in glioma patients: a systematic review on currently available data and the lack of evidence-based utilities.Meta-analysis/systematic reviewButenschoen VM, Kelm A, Meyer B, Krieg SM (2019) · DOI: 10.1007/s11060-019-03210-2

- [3]Intervention of pharmaceutical care on the quality-adjusted life years in diabetic foot ulcer patients-A randomized controlled study.RCT/clinical trialRaju BN, Mateti UV, Mohan R, D'Souza C, D'Souza N. (2026) · DOI: 10.4103/jehp.jehp_1066_25

- [4]An Exploratory Cost-Utility Analysis of Screening and Treating Immigrants in Canada for Hepatitis D.Research articleZhao J, Lewis D, Gamble JM, Butt ZA, Wong WWL. (2026) · DOI: 10.1111/jvh.70214

## 임상 시나리오

Choosing the Right Economic EvaluationCost-utility analysis for quality-weighted outcomes
When planning health education programs, select the evaluation method based on the outcome measure. If outcomes are expressed as QALYs (life-years weighted by health quality), use cost-utility analysis with cost per QALY gained.

Use cost-effectiveness analysis for natural units like cost per smoker who quits or unadjusted life-year saved. Use cost-benefit analysis only when both costs and outcomes are converted to monetary terms.

CautionDo not confuse cost-utility with cost-effectiveness when quality weighting is present. If outcomes are already known to be equal, use cost-minimization analysis instead.

## 핵심 개념

- **QALY** — Quality-adjusted life year; a measure combining length of life and health-related quality of life
- **Cost-utility analysis** — Economic evaluation comparing interventions by cost per QALY gained
- **Cost-effectiveness analysis** — Economic evaluation using natural units such as life-years gained without quality weighting
- **Cost-benefit analysis** — Economic evaluation converting both costs and outcomes into monetary units
- **Cost-minimization analysis** — Economic evaluation comparing only costs when outcomes are known to be equal

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