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Updated: Jul 12, 2026

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Operant Protocols for Assessing the Cost-benefit Analysis During Reinforced Decision Making by Rodents
Published on: September 10, 2018
On the estimation of cost-effectiveness ratios
1Centre for Health Economics, Stockholm School of Economics, Sweden.
Health Policy (Amsterdam, Netherlands)
|February 7, 1995
Summary
Birch and Gafni
Area of Science:
- Health Economics
- Resource Allocation
- Decision Analysis
Background:
- Critique of cost-effectiveness ratios (CERs) in healthcare resource allocation by Birch and Gafni.
- Concerns raised regarding CERs' ability to maximize health outcomes within budget constraints.
Discussion:
- The paper identifies two fundamental errors in Birch and Gafni's example.
- Error 1: Failure to exclude dominated programs when calculating incremental cost-effectiveness ratios (ICERs).
- Error 2: Neglecting the distinction between independent and mutually exclusive programs.
Key Insights:
- Correctly excluding dominated programs is crucial for accurate ICER estimation.
- Differentiating between independent and mutually exclusive programs is essential for valid cost-effectiveness analysis.
- The critique highlights the importance of methodological rigor in applying cost-effectiveness analysis.
Outlook:
- Accurate application of cost-effectiveness analysis is vital for informed healthcare resource allocation.
- A more objective discussion on cost-effectiveness analysis requires correct methodological implementation.
- Ensuring proper use of cost-effectiveness techniques will lead to better healthcare decision-making.
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