Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be?
Despite the growing literature on economic evaluation of health care programmes, little attention has been paid to the theoretical foundations of cost-effectiveness and cost utility analyses and the validity of the decision rules adopted as methods of achieving the stated goals. We show that although applications of the techniques can be used to pursue some managerial objectives in the context of highly constrained environments, such applications are inconsistent with both welfare economic objectives and the interpretations of the findings of these applications. Alternative strategies are identified as potential and practical methods for pursuing welfare economic objectives.
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ont, Canada.
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Birch
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Gafni
D002170:Canada; D003362:Cost-Benefit Analysis / Q000379:methods* / Q000706:statistics & numerical data; D003659:Decision Making, Organizational; D017048:Health Care Costs / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000191:economics* / Q000458:organization & administration; D006302:Health Services Research; D017059:Models, Econometric; D017063:Outcome Assessment, Health Care / Q000191:economics* / Q000458:organization & administration; D011788:Quality of Life; D012946:Social Welfare / Q000191:economics; D026712:Value of Life