Cost-utility and cost-benefit analyses: how did we get here and where are we going?

Cost-utility and cost-benefit analyses are currently the only tools available for evaluating whether the cost of an intervention is a good use of resources when compared with other ways that money could be spent on health care (allocative efficiency). Cost-utility analyses assess health in terms of length and quality of life using the quality adjusted life year whilst cost-benefit analyses measure health in monetary terms. The measurement of health gain with either approach has a number of problems and the accuracy of these measures is uncertain. Cost-benefit analysis has certain advantages when measuring improvements in mild diseases such as irritable bowel disease and dyspepsia, which are common problems in gastroenterology. The results of cost-benefit analysis may provide more transparent guidance for policy makers, doctors and patients.