The use (or rather the non-use) of cost-effectiveness data in priority setting decisions - are we underestimating the barriers to using health economics in real world priority setting decisions?: Comment on "Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden".

Sandra T Erntoft

doi:10.15171/ijhpm.2015.28

Abstract

After having practicing and researching health economics for nearly 15 years now, it has become clear to me that the use of cost-effectiveness data in priority setting decisions is rather a rare than a common practice. The Eckard et al. article though, describes a wonderful exception to this rule and a very good example of how it can be used when the conditions are right. However, do we fully understand what these conditions are? In this commentary article I will address some of the institutional and cultural conditions that need to be fulfilled in order for cost-effectiveness data to actually be used in priority setting decisions.

Highlights

Despite the large production of cost-effectiveness data worldwide, today it is fascinating that we know and understand so little about the actual use of health economic evaluations among the intended audience – the medical decision-makers
What happens after a health economic evaluation has been produced? Will it be used at all and, if so, how? Who uses economic evaluations and for what purposes? Are there differences in the use patterns between decision-makers at different healthcare levels? Are decision-makers able and willing to use them, and to what extent can the patterns be explained by contextual issues? Quite a few researchers have tried to address these questions in systematic literature reviews [1,2,3,4,5,6,7,8,9,10] over time
All reviews conclude that a health economic evaluation seldom is the decisive factor behind decision at regional or local level but sometimes on a national level

Summary

Introduction

Despite the large production of cost-effectiveness data worldwide, today it is fascinating that we know and understand so little about the actual use of health economic evaluations among the intended audience – the medical decision-makers. The most prominent health technology assessment agencies globally, in terms of using cost-effectiveness data, interestingly share the common feature that their decision-making process is relatively transparent and influenced by the theoretical framework “Accountability for Reasonableness” (A4R).

Results

Conclusion