Determining the optimal combinations of mutually exclusive interventions: a response to Hutubessy and colleagues

Hutubessy and colleagues have suggested a technique for decision-makers to employ in determining the optimal combination of interventions. This technique requires the adoption of Monte Carlo simulation analysis to identify the probability that a certain program will be included in an optimal mix given the uncertainty around the program's expected costs and benefits. In this response, it will be demonstrated that this methodology can lead to potential inefficiencies arising through the dependence of such probabilities on decisions relating to other programs and the failure to consider the opportunity costs of obtaining increased health benefits. A simple alternative approach is suggested which avoids these problems.