Use of formal benefit/cost evaluations in health system decision making

To examine actual use of formal benefit/cost and benefit/risk results in health system decision making by public and private healthcare organizations.

A direct survey with questions about healthcare decisions made by the respondent or the respondent's organization. The scope of this survey precluded meaningful quantitative analysis, thus descriptive and qualitative analyses were performed.

An initial questionnaire was tested in 2001 with 15 respondents in 4 countries. In 2002, a revised questionnaire was sent to a convenience sample of 116 individuals representing information users (providers, payers, and regulators) and information producers (technology firms and academics) in France, Sweden, the United Kingdom, and the United States. Responses were received from 104 people (89.7%).

Every information user employed benefit/risk analyses to accept or reject new interventions and delete existing technologies. In addition, 42.1% of information users also used formal benefit/cost results (cost effectiveness, cost benefit, and/or cost utility). Seven providers/payers in the United States, 1 in France, and 1 in the United Kingdom required such analyses, as did 1 UK regulator. Most did not produce their own analyses but relied on those of public organizations (eg, Food and Drug Administration, National Institute of Clinical Effectiveness), academics, and pharmaceutical firms.

A surprisingly high percent of information users (42.1%) employed any formal economic cost-effectiveness, cost-benefit, or cost utility analysis, CEA, CBA, or CUA evaluations in deciding whether to accept, pay for, or reject new interventions or to delete old interventions. Still, this figure was substantially higher than expected given the results of previous studies, nearly all of which found low use of formal benefit/risk and benefit/cost analyses.