Economic evaluation in health: saving money or improving care?

Abstract

SummaryEconomic evaluation, most commonly in the form of cost-effectiveness analysis, has now become an established tool of overall health financing policy. However, health policy makers choose to use or ignore the accumulated body of economic evidence for a variety of reasons. This policy review takes a step back and looks objectively at the appropriate role and use of cost-effectiveness analysis within the broader context of health system financing, and also discusses a series of technical limitations (and potential solutions) that impact on the generation of a genuinely comparable economic evidence base in health at the population level. While the explicit purpose of economic evaluation is to address the health financing objective of efficiency, the authors conclude that its application can be usefully extended to other health system goals, including financial protection (specification of core public healthcare packages for universal insurance) and equity in financing (assessment of intervention costs and effects by stakeholder or socioeconomic group). In order to contribute to these broader objectives, a sectoral or population-based approach to cost-effectiveness analysis is needed.