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July 11, 2007

Relevance of Cost-effectiveness Analysis to Clinicians and Policy Makers

Author Affiliations

Author Affiliations: Departments of Health Policy, Management, and Evaluation, and Medicine, University of Toronto (Drs Detsky and Laupacis), Departments of Medicine, Mount Sinai Hospital and University Health Network (Dr Detsky), Keenan Research Centre at the Li Ka Shing Knowledge Institute of St Michael's Hospital (Drs Detsky and Laupacis), Toronto, Ontario, Canada.

JAMA. 2007;298(2):221-224. doi:10.1001/jama.298.2.221

One of the main objectives of educating clinicians and policy makers is to help them make better decisions. Should I order blood cultures for this patient? Can this patient with chest pain safely go home or should she be admitted to the hospital? Do I recommend implementing a hospital-wide influenza immunization program for all patients and health care workers? Should my hospital buy a new information technology system?

Most clinicians and health care administrators like to think these decisions are based on the rational use of all relevant information. The traditional patient-physician relationship of 50 years ago required that the physician base his or her recommendation on the clinical risks and benefits of each option. Costs were considered only if the patient bore them directly. Health care is now much more expensive, and a variety of insurance schemes pay for much of it. These third-party payers are definitely interested in the costs as well as the benefits and adverse effects of therapies.1 Thus, it is not surprising that the measurement of both the costs and benefits of new health care technologies, particularly drugs, has increased greatly in the last 3 decades. Reimbursement parties insist on it.

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