Developing appropriate measures of the benefits of complementary and alternative medicine.

Complementary and alternative medicine (CAM) is growing in popularity and consumes increasing amounts of resources. Economic evaluations such as cost-effectiveness analyses (CEAs) are intended to inform decision-makers about the relative efficiency of different interventions, including CAM. To be generalizable, economic evaluations should use the same metric to assess health benefits--e.g. quality-adjusted life years (QALYs). However, the recurrent conditions for which CAM is typically used suggest that the health benefits of CAM will manifest themselves primarily as quality-of-life improvements that appear in CEA as 'utilities' attached to health states. Therefore, appropriate utility measures will be critical to the production of valid CEAs of CAM therapies. Some economists assert that the process of health care, as well as its outcome, can contribute to patient utility. This essay argues that process utility is especially relevant to CAM; accurate assessment of process utility will be important to valid economic evaluations of CAM; existing utility assessment methods do not directly account for process utility; and, therefore, techniques such as qualitative analysis that can inform more appropriate and complete assessments of the benefits of CAM should be explored. The heterogeneity of CAM modalities suggests that the arguments made in this essay will apply with similar force to economic evaluation of conventional therapies with which CAM is likely to be compared.