Health, economic evaluation, and critical care

In the past 2 decades, societal spending on health care has become an international concern. The United States currently spends more than 1.6 trillion dollars per year on health care--approximately 15% of the gross domestic product. The provision of care to critically ill patients accounts for a disproportionate share of these health care dollars--approximately 13% of hospital costs, 4% of national health expenditures, and 0.5% to 1% of the gross domestic product. This enormous investment necessitates careful evaluation of our interventions and their associated expense. Economic evaluation can aid policy makers and health care professionals in comparing the relative and incremental value of disparate and expensive therapies and also inform decisions about which interventions provide good value for the health care dollar. In this review, we will highlight landmark publications over the past decades that have helped to shape the field of economic evaluations for critical care medicine.