An economic perspective on evidence-based patient choice in surgery

The aim of the present paper is to provide an economic perspective on current and emerging issues relating to surgical decision-making. The central issue discussed in the paper is choice and how this relates to patient management. The paper explores three factors that may influence the nature of choice; they are--evidence-based medicine, patient involvement in making choices and the role of cost-effectiveness analysis in surgery. Together, these factors are driving a shift from the traditional model of care based on medical beneficence to one based more on individual patient autonomy. This shift has been described as a move towards 'evidence-based patient choice' (EBPC). The concept of EBPC is relatively new and ill defined. Yet it encapsulates what is happening now and what will occur more dramatically in the future; that is, the nature of the relationship between surgeon and patient is changing. We hope that this paper will provoke discussion on the concept of EBPC and cost-effectiveness analysis in surgical decision-making.