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June 21, 2006

Cost-effectiveness Analysis in the United States—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(23):2722-2723. doi:10.1001/jama.295.23.2722-b

In Reply: Dr Wynia is correct that CEA is often complex and limited and may be sensitive to small changes in its inputs or structure. For years, persons advocating a straightforward reckoning of the marginal benefits and costs of new medical innovations have faced complaints that CEA is not up to the task.1 That is why the lessons to be learned from NICE are so germane to US sensibilities. Cost-effectiveness analysis is not more technically sound or reliable on the other side of the Atlantic. Yet NICE uses it as the cornerstone of its guidance and has withstood the resulting industry and political pressures. No one can say, however, that NICE has worshipped blindly at the idol of economic modeling. Great effort goes into independent dissection of the nuances of economic models to understand their limitations, and deep thought and transparent discussion are applied to the social values that may not be captured by the root utilitarian philosophy underlying CEA.2

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