Intended for healthcare professionals

Education And Debate Economics notes

Perspectives in economic evaluation

BMJ 1998; 316 doi: (Published 16 May 1998) Cite this as: BMJ 1998;316:1529
  1. Sarah Byford, research fellowa,
  2. James Raftery, professor of health economicsb
  1. a Centre for Health Economics, University of York, York YO1 5DD
  2. b Health Economics Facility, Health Services Management Centre, University of Birmingham, Birmingham B15 2RT
  1. Correspondence to: Ms Byford

    This is the second in a series of occasional notes on economics

    Before an economic evaluation begins, the perspective of the study should be determined, as it may have implications for trial design.1 Since economic evaluations are often used to assess the relative efficiency of alternative healthcare interventions, the perspective commonly taken is that of the health service.2 Because of its foundations in welfare economics, however, health economics is concerned with society's welfare. It therefore argues that an economic evaluation should include the impact of an intervention on the welfare of the whole of society, not just on the individuals or organisations directly involved.

    Central to economic theory is the question of how to get the most benefit from the scarce resources available to a society. An economic evaluation which confined itself to the NHS's perspective could determine the mix of interventions that would maximise health outcomes within the limited NHS budget. However, this would not necessarily maximise the welfare of society within resources available (gross national …

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