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The effectiveness of cost-effectiveness analysis in containing costs
1Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.
Journal of General Internal Medicine
|November 3, 1998
Summary
Cost-effectiveness analyses (CEAs) often support additional health expenditures rather than low-cost alternatives. Industry funding may influence these conclusions, warranting further investigation into CEA objectivity.
Area of Science:
- Health Economics
- Health Services Research
- Medical Decision Making
Background:
- Cost-effectiveness analyses (CEAs) are intended to evaluate health expenditure value.
- CEAs are hoped to help contain rising healthcare costs.
- This study examines whether CEAs discourage additional spending.
Purpose of the Study:
- To determine the frequency with which cost-effectiveness analyses discourage additional health expenditures.
- To analyze the conclusions of published CEAs regarding healthcare spending.
Main Methods:
- Searched Abridged Index Medicus (1990-1996) for CEAs reporting explicit cost-effectiveness ratios.
- Extracted incremental cost-effectiveness ratios and health effects (life-years, QALYs).
- Categorized conclusions and analyzed funding sources.
Main Results:
- Of 109 CEAs, 53% supported additional expenditure, while 26% supported low-cost alternatives.
- Cost-effectiveness ratios varied widely, with overlap between categories.
- Industry-funded studies were significantly more likely to support additional expenditure (9 of 10).
Conclusions:
- CEA authors are more prone to supporting increased spending than cost-saving measures.
- No clear consensus exists on cost-effectiveness thresholds for justifying expenditure.
- Funding source, particularly industry funding, appears to influence CEA conclusions.
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