Economic aspects of clinical decision making: applications in patient care

An overview of the techniques of cost-effectiveness analysis as they apply to clinical decision making is presented, and ways that the techniques can assist decision makers in a limited-resource environment are identified. Most applications of cost-effectiveness analysis concern a problem in which a choice must be made between different ways of accomplishing a given clinical goal, such as treating a particular illness. As such, these applications involve comparisons between competing and mutually exclusive strategies and attempt to identify those strategies that provide the greatest benefit for a given set of resource constraints. The need for these analyses continues to increase as a consequence of the growing importance of rate-based and capitated (as opposed to cost-based) methods of paying for patient care. Despite this growing need, most decision makers will not want or be able to conduct such analyses on a regular basis; they may nonetheless benefit from formal studies of clinical problems conducted and reported by others. The validity and quality of these reports, however, need to be carefully assessed before decisions can be based on such information. Properly done, cost-effectiveness analyses can be powerful tools in clinical decision making, particularly as the concern with providing quality care in a cost-constrained environment continues to grow.