Strengthening Cost-Effectiveness Analysis for Public Health Policy.
Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs.
Institute for Health, Health Care Policy, and Aging Research, and Department of Economics, Rutgers University, New Brunswick, New Jersey;. Electronic address: lrussell@ifh.rutgers.edu.
Louise B
LB
Russell
Department of Health Systems and Policy, Rutgers School of Public Health, Rutgers University, New Brunswick, New Jersey.
Anushua
A
Sinha
D003362:Cost-Benefit Analysis / Q000191:economics*; D006291:Health Policy / Q000191:economics*; D006801:Humans; D011634:Public Health; D019057:Quality-Adjusted Life Years