Philosophical concerns regarding cost-effectiveness analyses

Secondary to the confluence of rising health care costs and higher quality data on the effectiveness of various medical interventions, cost-effectiveness analyses are becoming increasingly common. In this paper, we aim to assess the strengths and limitations of these analyses such that their interpretation and implementation can be maximized. The strengths of cost effectiveness analyses rest on the 'bang-for-the-buck' information they provide; allowing considerations of costs to be tied with therapeutic effectiveness - thereby (1) assisting in the decision making process between competing interventions for a particular disease process; and (2) between therapies to be used and diseases to be addressed via rationing. The weaknesses include (1) outcomes which depend greatly upon the methodologies used thereby confounding comparisons across studies; and (2) outcomes which, if used as the primary foundation of decision making, often conflict with societal values and desires. Accordingly, great care is suggested in interpreting the results of these studies and implementing such results in therapeutic or rationing decision making. (C) 2009 Elsevier Ltd. All rights reserved.