Response to Drs. Corso, Grosse, and Finkelstein

Abstract

Dear Sir: We welcome the part-recognition and part-rebuttal by Corso et al. of the arguments put forward in our recent article. As Corso et al. have done with our article, we also acknowledge the validity of some of the arguments they make, thus providing fertile common ground for debate about the usefulness of cost-of-illness (COI) studies and economic evaluation more generally. Corso et al. contend that COI studies “can be valuable tools for promoting attention to the economic burden imposed by specific illnesses.” We are not sure how much progress can be made on whether this is the case without, perhaps, some empirical evidence on their added value over and above estimates of morbidity and mortality. This would require some work not only on the perceived usefulness (by decision makers) of such studies but also on decision makers’ interpretations of them. Corso et al. also state that COI studies can be a useful first step in economic evaluation. Here, we suppose the emphasis should be on can be, the approach taken to any economic evaluation largely depending on circumstances and the expert judgments of the research team as to how best to approach such circumstances. However, for both promoting attention to diseases and as a first step in economic evaluation, we would doubt that COI estimates are always necessary. If, as Corso et al. imply, COI estimates are being used just as pieces of information by the government in a complex decision-making process, we feel more comfortable. Obviously, many pieces of information will feed into such decisions about research and care priorities. If anything, our concern is not to place too much emphasis on the size of the problem, but rather, the payoff from interventions vis-à-vis other uses of resources. These will not always be in congruence. Finally, we also welcome the cautions highlighted by Finkelstein and Corso (1) with respect to the potential flaws of both economic evaluation and COI studies (1,2). Our only addition, or proposed substitution, would be to say that we need to debate further the state of the science of economics more generally, rather than just COI studies, in terms of their contributions to the allocation of scarce public health resources.