To the Editor.—
We agree with Anderson and Moser1 on the desirability of a method to help society compare different health care options. However, there are problems with the interpretation of the benefit-cost/ utility (BCU) ratio when savings exceed cost (ie, when the BCU ratio is negative). If a lower BCU ratio results from a greater cost savings, society would rightly choose the more negative BCU ratio, as in the case of positive BCU ratios. However, the BCU ratio will also decrease when fewer well-years are produced. In this case, a more negative BCU ratio would be less desirable.For example, suppose a course of action produced a net savings of $1,000 and an increase of one well-year. Then the BCU ratio would be —1,000. If a course of action were possible so that a net savings of $2,000 produced the same one well-year, then the BCU ratio would be
Steinbach JH, Hardison WGM. Comparing Health Care Options Using the Cost-Benefit Utility Ratio. JAMA. 1986;255(6):747. doi:10.1001/jama.1986.03370060061015
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