The Interpretation of results of economic evaluation: explicating the value of health

Abstract

Theoretically it can be proven that an optimal allocation of resources within a constrained budget can be reached by considering cost-effectiveness ratios (CERs). In this paper, the complex priority setting process regarding compatible and incompatible alternatives of medical interventions is clarified. Priority setting in the context of compatible alternatives may refer to the selection of more than one, possibly all, alternatives. Inherent to a set of incompatible alternatives is that only one alternative can be selected. This latter situation frequently occurs in health care. The value that society attaches to a unit of effectiveness (e.g. a QALY) has an important impact on the priority ranking of medical interventions. By explicating this value and by using the 'net-value' approach, a graphical framework is presented that allows decision-makers a better understanding on the impact of particular levels of these values on their optimal policy choices. For illustrative purposes, it is shown that by the erroneous application of decision rules, some recent papers have provided sub-optimal recommendations for health care policy.

Cost-effectiveness of adding-on new antiepileptic drugs to conventional regimens in controlling intractable seizures in children

“…Since the value that Iranian society recognize for health outcomes is unknown, interpreting the results express complicacy [13]. WHO guidelines recommend comparing the cost-effective ratio (CER) with the GDP per capita of the country [14].…”

Implementing guidelines into clinical practice: what is the value?

“…guideline trials and implementation trials) is synthesized, while trials concentrate on deriving specific empirical evidence on practice [10,11,17]. By coupling decision modelling with evidence synthesis, possibly complemented with the collection of additional data, decision makers are able to fully exploit the prospects of a total net benefit approach to economic evaluation, in that the uncertainty associated with decision making about guidance plus implementation can be unravelled and the use of resources to improve patient care can be optimized [21–24,29,31].…”

Policymaking based on CERs: changes in costs are not the same as changes in benefits

“…As many authors have suggested, CERs can be visualised in graphic representations [[1,2,16-18], and [19]]. These graphs may help to identify the most cost-effective interventions within a set of compatible (mutually non-exclusive) alternatives.…”