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Health Policy and Cost-Effectiveness Analysis: Yes We Can. Yes We Must.
- John B. Wong, MD;
- Cynthia Mulrow, MD, MSc, Deputy Editor; and
- Harold C. Sox, MD, Editor
- From Tufts University School of Medicine, Boston, MA 02111, and American College of Physicians, Philadelphia, PA 19106.
Just over 40 years have passed since the publication of the first cost-effectiveness analysis that arguably influenced major U.S. health policy (an analysis of Medicare coverage of renal replacement therapy in 1972) (1). In this issue, Pletcher and colleagues (2) use the same approach to answer an analogous policy question: What is the best strategy for using statins to prevent coronary heart disease (CHD) in the United States—following the Adult Treatment Panel III (ATP III) guidelines or treating on the basis of 10-year risk, attained age, or sex-specific alternative age thresholds?
Before turning to their answer, we will first provide a brief introduction to cost-effectiveness analysis. Many find this technique to be methodologically complex and opaque. Although a complex model can be opaque to all but the expert, the principles of cost-effectiveness analysis are straightforward. With these principles in hand, the reader can engage in an important debate: Should the federal government use cost-effectiveness analysis to inform its policy decisions about health care? This question, abstract only a few years ago, takes on compelling urgency in a time of worldwide fiscal crisis.
What does cost-effectiveness analysis offer health policy? According to Weinstein and Stason (3), its purpose is to identify the important factors affecting resource allocation between complex, uncertainty-laden medical detection and treatment problems; provide a basis for allocating resources among diseases; awaken decision makers to the reality of limited resources; and offer a rational approach to decision making when resources are limited. According to 1 health economist (4), public policy should strive to equalize the relationships across diseases between the additional health care expenditures on a disease and their benefits. In principle, cost-effectiveness analyses provide an explicit, standardized measurement of the value of alternative health policies to society.
Policymakers in the United States need some basic …
