Lessons from Cost-Effectiveness Research for United States Public Health Policy

Abstract

The application of cost-effectiveness analysis to health care has been the subject of previous reviews. We address the use of economic evaluation methods in public health, including case studies of population-level policies, e.g., environmental regulations, injury prevention, tobacco control, folic acid fortification, and blood product safety, and the public health promotion of clinical preventive services, e.g., newborn screening, cancer screening, and childhood immunizations. We review the methods used in cost-effectiveness analysis, the implications for cost-effectiveness findings, and the extent to which economic studies have influenced policy and program decisions. We discuss reasons for the relatively limited impact to date of economic evaluation in public health. Finally, we address the vexing question of how to decide which interventions are cost effective and worthy of funding. Policy makers have funded certain interventions with rather high cost-effectiveness ratios, notably nucleic acid testing for blood product safety. Cost-effectiveness estimates are a decision aid, not a decision rule. 365

Projected Cost-effectiveness of New Vaccines for Adolescents in the United States

“…The rule has been that interventions that cost less than $50 000 per QALY saved are defined as societally cost-effective and that interventions between $50 000 and $100 000 should only be adopted if there are additional unpriced benefits such as relieving fear in the community. 55 This rule and its cost thresholds are highly contested as baseless of any economic theory or expert support. 55 Indeed, recent extensive and theoretical studies may suggest threshold values that are much higher 56,57 and/or context specific.…”

Market Potential of Folate Biofortified Rice in China

“…As a consequence, economic evaluation studies of health interventions are mainly based on CEA, while the CBA is less preferred in the (environmental) health (care) sector (WHO, 2000;Grosse et al, 2007;Ngorsuraches, 2008). Although the cost-benefit concept certainly has its merits over the concept of cost-effectiveness, e.g.…”

“…From development to commercialization, the following categories of costs occur: (advanced) R&D costs, country-specific costs (field trials, backcrossing costs, large scale feeding tests and regulatory costs), social marketing costs and maintenance breeding costs. In this way, the CEA aims to evaluate the intervention from the point of view of the broad society, in line with the WHO (Evans et al, 2005), U.S. Panel on Cost-Effectiveness in Health and Medicine (Gold et al, 1996) and CDC (Grosse et al, 2007 (Evans et al, 2005(Evans et al, , p. 1137. Following Musgrove & FoxRushby (2006), the underlying CEA does not include indirect costs, such as individual costs of buying and consuming the biofortified crop (travel costs, work time losses), nor the costs related to the decreased share of other interventions (e.g.…”

“…CEA studies of folic acid supplementation programs are rarely existing (Grosse et al, 2007). Another difficulty is that folic acid is often promoted in combination with iron, i.e.…”

“…Even if China would not choose to begin the production of GM rice, the results are not considered to be useless for health policy. As Grosse et al (2007) state, economic evaluation study results that do not influence policy makers in their resource allocation towards GM biofortified interventions could contribute by helping them to apply other, alternative interventions to tackle malnutrition.…”