Cost-effectiveness: definitions and use in the gastroenterology literature

In this era of rapid change in our health care system, we will be required to demonstrate that our practices and procedures in gastroenterology are both effective and cost-effective. In the face of rising national health care expenditures, the medical profession confronts an increased demand to justify practices and to demonstrate the value of its services. This has led to both an expansive literature examining the cost-effectiveness of practices and procedures and an alarming disparity in the definition and use of the term "cost-effectiveness." Many reports may be lacking appropriate documentation of costs and benefits, the critical components for the determination of cost-effectiveness.

The purpose of this article was to define what is meant by a "cost-effective" intervention, with special reference to gastroenterology.

The varied use of the term "cost-effective" in the gastroenterology literature is illustrated. Accepted definitions of the term are provided, and suggested uses are outlined. The value judgements that must be made in funding decisions are presented, and the parameters that may be used to determine the cost-effectiveness of a procedure or practice are discussed.

Cost-effectiveness as it applies to GI medicine is defined, and appropriate and inappropriate uses of the term are illustrated. It is only through effective communication and precise definitions that we will be able to determine the cost-effectiveness of our practices in gastroenterology.