Evaluating the Cost-Effectiveness of Clinical and Public Health Measures

Abstract

Cost-effectiveness analysis, an analytic tool that expresses as a ratio the cost of obtaining an additional unit of health outcome, can help decision makers achieve more health protection for the same or less cost. We characterize the state of the cost-effectiveness analysis literature by reviewing how this technique is applied to various clinical and public health interventions. We describe the results of cost-effectiveness analyses for over 40 interventions to reduce cancer, heart disease, trauma, and infectious disease. The cost-effectiveness ratios for these interventions vary enormously, from interventions that save money to those that cost more than $1 million per year of life gained. The methods used to derive the cost-effectiveness ratios also vary considerably, and we summarize this variation within each health area. Greater uniformity of analytical practice will be necessary if cost-effectiveness analysis is to become a more influential tool in debates about resource allocation.

Cost effectiveness of mammography screening for Chinese women

“…[43][44][45][46][47][48] Although there is no consensus on what constitutes an acceptable ICER, the U.K.'s National Institute for Health and Clinical Excellence (NICE) typically has accepted technologies as cost effective if the ICERs are below US$36,000 to US$54,000 (US$1 5 £0.55) per QALY, although NICE has (very rarely) accepted technologies (not related to screening) with larger ICERs up to US$90,000. 43 The Canadian Coordinating Office for Health Technology Assessment considers US$50,000 per QALY as relatively unattractive for their therapeutics program.…”

Lessons from Cost-Effectiveness Research for United States Public Health Policy

“…An intervention that dominates the baseline scenario (usually the status quo) in a CEA is said to be cost saving. Only a minority of health care interventions are cost saving in the sense that averted direct costs of care, including nonmedical costs, exceed intervention costs (42). Contrary to popular belief, cost-effectiveness is not the same as cost savings, and most interventions that are regarded as cost effective are not cost saving (29,45,105).…”

Cost savings associated with 10 years of road safety policies in Catalonia, Spain

“…44 In fact, economic assessments have proved the efficacy of many of the recommended measures, particularly the use of speed control radar, airbags, helmets and headlights during the day. [45][46][47][48] This study demonstrates that implementing evidence-based road safety policies brings benefits: Catalonia has experienced the largest change in the health of its population since the beginning of the century, in large part as a result of such policies. The implementation of these policies was made possible by explicit and continuing political commitment supported by society in general, which is very sensitive to the testimony of traffic injury victims, and by the mass media.…”