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Abstract
Methods of evaluating socioeconomic relationships have evolved over many years, and
a number of specific approaches have been developed. Among the techniques available,
cost-effectiveness analysis (CEA) has emerged as the most widely used and accepted
method. Yet, despite considerable effort by the analytical community to refine this
technique into one more useful for making health policy decisions, much debate and
confusion still persist among analyst, readers, and policymakers concerning methods
standards and the overall usefulness of CEA in resource allocation decision making.
Thus the purpose of this paper is to summarize, critically examine, and commment on
existing recommended methods for socioeconomic evaluation of health care interventions.
In particular, we examine an exhaustive set of component methods within the general
area of cost-effectiveness and comment on areas of apparent consensus and debate.
Our review reveals many areas of agreement and many yet to be resolved. Analysts generally
agree on the components of the overall framework for an analysis; basic methodologic
principles; the general treatment of costs; the principle of marginal analysis; the
need for and general approach to discounting; the use of sensitivity analysis; the
extent to which ethical issues can be incorporated; and the importance of choosing
appropriate alternatives for comparison. The principal areas in which disagreement
still persists are choice of study design, measurement and valuation of health outcomes
including conversion of health outcomes to economic values, transformation of efficacy
results into effectiveness outcomes, and the empirical measurement of costs.
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© 1995 Published by Elsevier Inc.
