A review of cost‐effectiveness analyses

Abstract

A large number of cost-effectiveness analyses has been published over the last 16 years. Cost-effectiveness ratios (costs per year of life gained or quality adjusted year of life gained) derived through cost-effectiveness analysis can be used to compare the efficiency of different health-care programmes, although such comparisons should be made cautiously because of the uncertainties associated with many estimates of cost and effectiveness. Considering cardiovascular disease control programmes, for example, some preventive strategies, such as advice to quit smoking, or exercise programmes, are more cost-effective than antihypertensive treatment or coronary artery bypass grafting. However, cholestyramine therapy for prevention of coronary heart disease is less cost-effective than either of these treatments, and there are marked variations in the cost-effectiveness of many interventions, with factors such as the age group treated, frequency of treatment and level of parameters such as diastolic blood pressure, playing a role. Cancer control programmes are also considered in this paper. Cost-effectiveness analysis can be useful for assessing the relative costs and effectiveness of different programmes, but all relevant factors for policy-making and resource allocation can rarely be incorporated in a single analysis.