A seasonal cost effectiveness analysis: the last Noel?
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7378.1456 (Published 21 December 2002) Cite this as: BMJ 2002;325:1456
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To the Editor, BMJ:
The cost-effectiveness analysis of Christmas by Isaacs and Fitzgerald
(BMJ 2002;325:1456) borders on the truly humorous and clever, but is
nonetheless an ill-informed and rather unfortunate seasonal piece. By
focusing so heavily on Christmas spending, the authors reveal their
misunderstanding of the occasion. It is not surprising then that they
erred significantly and somewhat offensively by stating that the only
value of Christmas they could include is reindeer manure. Perhaps this
reflects the statement reported in the Culliford editorial in this same
BMJ issue indicating that “church attendance is low and falling.”
Clearly, Isaacs and Fitzgerald should have done a cost-benefit
analysis rather than a cost-effectiveness analysis so they could include
the value of eternal lifesaving afforded by the events celebrated at
Christmas. This is a major shortcoming, indeed an insurmountable
oversight that should have resulted in publication rejection for improper
methods and failure to include all relevant outcomes. Omitting a
quantification of the value of eternal life, although difficult for some,
renders this bit of research much less profound than reindeer manure!
The initial premise of the report (never touched on again after the
first paragraph) was that the money spent on Christmas might better be
targeted on improving the health care of the nation. Since the events
celebrated at Christmas offer the opportunity of eternal life for all
nations, the folly of the authors' hypothesis is obvious. I propose
instead that some of the time given to Christmas spending might be
profitably targeted toward the reason for the season.
Merry Christmas to All,
James R. Barnes
Health Economist
Fort Worth, Texas,
USA
Competing interests:
None declared
Competing interests: No competing interests
In a pioneering economic analysis of Christmas, Drs. Isaacs and
Fitzgerald discovered that Christmas celebrations cost money. From this,
they concluded that cancelling Christmas would save money.
Omitted (like everything else) from Drs. Isaacs and Fitzgerald's
analysis was an assessment of the economic costs of actually cancelling
Christmas. Using similar methodology, my own economic analysis duplicates
their finding that Christmas costs money, but it raises questions about
their assumptions that cancelling Christmas would create net cost savings.
The current study shows that consideration of the costs of a Christmas ban
would result in unacceptable POLY-adjusted increases in spending.
METHODS: First, I conducted a private personal survey to establish a
set of consensus assumptions. This private personal survey confirmed that
I agreed with my own opinions. Next, I entered the consensus assumptions
into a proprietary socio-economic model optimized to achieve the desired
results. Finally, I adjusted the results to minimize the residual error
of the expectated result.
RESULTS: Politicians could be expected to exagerate the direct cost
savings from cancelling Christmas by 24.8267828 +/- 8.82963885 fold.
Conservative estimates that politicians spend an average of 19.28956092 +/
- 7.298309945 times ten-year hypothetical savings each year and slip 17.3
(range 6 to 60) riders through with each spending bill adds 8327.92388649
+/- 2345.296593 times current Christmas expenditures in estimated indirect
costs. The direct costs for government education and enforcement programs
to cancel Christmas were estimated be 110.37852204 +/- 68.38284637 times
current Christmas expenditures during the first year, annually increasing
by 7.582 +/- 3.853 times whichever index of inflation justified the
largest buget. Adjusting for the costs of Charles Dickens' "A Christmas
Carol" performances in every school, church, and theator plus the
performers' parents' lost wages and adding a term for unknown costs led to
a final POLY-adjusted cost of 829659398.9283095708409 +/-
829659398.9283095708409 times current Christmas expenditures. A post-hoc
quality-of-life (QOL) assessment of the effects of being barraged by
incessant reditions of "A Christmas Carol" revealed a QOL Adjusted Year
(QOLAY) cost exceeding the G7's combined national deficits, making it cost
-ineffective ("p" < 1 googleth, Fisher's inexact guess) as compared to
novel reference standards for maximally acceptable QOLAY costs (eating
either one dried-out fruitcake or five holiday tins of stale
buttercookies).
CONCLUSION: This economic analysis clearly demonstrated that any
attempt to cancel Christmas is likely to prove less cost-effective than
responding to errant celebrations with a hearty "Bah! Humbug!" (results
not shown).
Competing interests:
President, Ebineezer Fan Club.
Competing interests: No competing interests
Dear Sir,
I would like to point out the results of your cost-effectiveness
study are unlikely to be generalisable between international locations.
Nevertheless I recommend that the NHS Economic Evaluation Database (NHS
EED) gives it a full review in order to comment on its applicability to
contexts outside in which the study was conducted.
Your sincerely
Francis Pang
Competing interests:
None declared
Competing interests: No competing interests
Dear Sir,
I have searched in vain for the accompanying RCT of the effectiveness
of Christmas.
Has the recently announced policy been abandoned so soon?
Competing interests:
None declared
Competing interests: No competing interests
post christmas reflections
The authors , without an MBA ( Making Blairite Assessments) between
them, appear singularly unQALYfied to comment on this topic although their
conclusions are correct. They have omitted any number of vital economic
measurements of which I can mention only a few:
The SOLY ( Socks Only Loss Yield)- the cost of having clothes let out
in the New Year which always exceeds the value of 2 pairs of plain socks
crushed between the jelly beans in the Xmas stocking.
The TOLY ( Tradesman Over Lunch Yield) - the ratio of total expense
for employing both a professional carpet cleaner in January and an
emergency electrician at treble rates when the decorations fuse all street
lights , divided by the cost of Christmas Lunch.
The VOLY ( Very Ordinary Largesse Year) - the large difference in
value between presents given and received.
I could go on but got distracted by Santa flying back after his last
delivery. I asked him for a comment but can't possibly have heard
correctly as I thought he said " Ho, Ho, Ho and what about the cost of
the National Elf Service?"
Competing interests:
numerous unpaid attempts at writing humerous articles
Competing interests: No competing interests