Portfolio evaluation of health programs: a reply to Sendi et al.
Sendi et al. (Soc. Sci. Med. 57 (2003) 2207) extend previous research on cost-effectiveness analysis to the evaluation of a portfolio of interventions with risky outcomes using a "second best" approach that can identify improvements in efficiency in the allocation of resources. This method, however, cannot be used to directly identify the optimal solution to the resource allocation problem. Theoretically, a stricter adherence to the foundations of portfolio theory would permit direct optimization in portfolio selection, however, when we include uncertainty in our analysis in addition to the traditional concept of risk (which is often mislabelled uncertainty) complexities are introduced that create significant hurdles in the development of practical applications of portfolio theory for health care policy decision making.
Bridges
John F P
JF
Department of Epidemiology and Biostatistics, Health Services Research Division, Case Western Reserve University, School of Medicine, Room WG57, 10900 Euclid Avenue, Cleveland, Ohio 44106-4945, USA. healtheconomics@hotmail.com
Terris
Darcey D
DD
D003362:Cost-Benefit Analysis; D003659:Decision Making, Organizational; D003661:Decision Support Techniques; D015276:Health Care Rationing / Q000191:economics* / Q000379:methods; D006302:Health Services Research; D006801:Humans; D007449:Investments / Q000191:economics*; D017059:Models, Econometric; D012306:Risk; D035501:Uncertainty