Robert C. Burack, MD, MPH
Potential Financial Conflicts of Interest: None disclosed.
Burack R.; Clarifying the Principles of Cost-Effectiveness Analyses. Ann Intern Med. 2009;151:142. doi: 10.7326/0003-4819-151-2-200907210-00016
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Published: Ann Intern Med. 2009;151(2):142.
TO THE EDITOR:
In their recent editorial (1), which accompanies the cost-effectiveness analysis by Pletcher and colleagues (2), Wong and associates explain the rationale supporting cost-effectiveness analysis as a guiding principle in the allocation of health care resources. Unfortunately, I found the editorial's example of this principle unclear and thus find it difficult to apply the method to other questions of health care–related resource allocation.
Using the incremental cost-effectiveness ratio estimates provided by Pletcher and colleagues, Wong and associates project the gain in quality-adjusted life-years expected if $1 million is allocated to primary prevention under different statin scenarios in a hypothetical cohort of 154 persons. However, without additional information on the distribution of heart disease and the associated allocation of costs to prevention or treatment at baseline in that cohort, I cannot recreate their calculation of the point at which total cost exceeds the available budget of $1 million. This is not to take issue with the important conclusions of the editorial—that a trade-off exists between prevention and treatment, and a fixed budget will constrain adoption of less efficient strategies. However, at least for some readers, a clearer explanation of the calculation could help further advance this argument.
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