Is economic evaluation in touch with society's health values?

doi:10.1136/bmj.329.7476.1233

BMJ 2004;329:1233-1236 (20 November), doi:10.1136/bmj.329.7476.1233

Education and debate

Is economic evaluation in touch with society's health values?

Joanna Coast, senior lecturer in health economics¹

¹ Department of Social Medicine, University of Bristol, Bristol BS8 2PR jo.coast@bristol.ac.uk

Health funding is increasingly based on the results of economicevaluation. But current methods fail to consider all society'shealth objectives and are too complex for policy makers to use

The first 150 words of the full text of this article appear below.

Introduction

The technical expertise required for conducting economic evaluationsand interpreting their results continues to increase. Currentbest practice includes cost effectiveness acceptability curves,net-benefit frameworks, and probabilistic modelling.¹ Thesemethods are valuable, but by generating a pseudoscientific auraaround economic evaluation, they camouflage critical weaknessesin current techniques. In this article, I describe the evolutionof economic evaluation in health care (see box for terminology),explore the assumptions underlying current approaches and theresulting concerns, and suggest an alternative approach.

Why do we need economic evaluation?

People who are not economists often find it difficult to understandthe importance of the theory behind the comparison of costsand effects. After all, if we compare two washing machines ofequal cost and one works for 10 years and the other for 15,it is clear that the machine lasting 15 years is a better buy.The need for theory arises, however, because interpersonal ratherthan within individual . . . [Full text of this article]

Welfare economics

Non-welfare approaches

Camouflaged assumptions associated with recent advances

An alternative route

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