Pharmacoeconomic Evaluation Data Collection Form
Please complete all fields below to provide the necessary data for a pharmacoeconomic evaluation.
Study Title
*
Type of Pharmacoeconomic Analysis
*
Please Select
Cost-Minimization Analysis
Cost-Effectiveness Analysis
Cost-Utility Analysis
Cost-Benefit Analysis
Other
Intervention Description
*
Comparator(s)
*
Target Population
*
Study Perspective
*
Please Select
Societal
Healthcare System
Payer
Patient
Other
Time Horizon (years)
*
Main Cost Components Considered
*
Main Outcomes Measured
*
Data Sources Used
*
Submit
Should be Empty: