The Role of Cost-Effectiveness Analysis in Health and Medicine

Abstract

OBJECTIVE: To develop consensus-based recommendations guiding the\nconduct of cost-effectiveness analysis (CEA) to improve the comparability and\nquality of studies. The recommendations apply to analyses intended to inform\nthe allocation of health care resources across a broad range of conditions and\ninterventions. This article, first in a 3-part series, discusses how this\ngoal affects the conduct and use of analyses. The remaining articles will\noutline methodological and reporting recommendations, respectively. \nPARTICIPANTS: The Panel on Cost-Effectiveness in Health and Medicine, a\nnonfederal panel with expertise in CEA, clinical medicine, ethics, and health\noutcomes measurement, was convened by the US Public Health Service (PHS). \nEVIDENCE: The panel reviewed the theoretical foundations of CEA, current\npractices, and alternative procedures for measuring and assigning values to\nresource use and health outcomes. CONSENSUS PROCESS: The panel met 11 times\nduring 2 1/2 years with PHS staff and methodologists from federal agencies. \nWorking groups brought issues and preliminary recommendations to the full\npanel for discussion. Draft recommendations were circulated to outside experts\nand the federal agencies prior to finalization. CONCLUSIONS: The panel's\nrecommendations define a "reference case" cost-effectiveness analysis, a\nstandard set of methods to serve as a point of comparison across studies. The\nreference case analysis is conducted from the societal perspective and\naccounts for benefits, harms, and costs to all parties. Although CEA does not\nreflect every element of importance in health care decisions, the information\nit provides is critical to informing decisions about the allocation of health\ncare resources.