COST-EFFECTIVENESS LEAGUE TABLES - MORE HARM THAN GOOD

In recent years it has become fashionable to make comparisons (in 'lea gue tables' or rankings) between health care interventions in terms of their relative cost-effectiveness, in cost per life-year or cost per quality-adjusted life-year gained. However, concerns have been raised about the unthinking use of league tables and some authors have questi oned the theoretical basis of their construction. In this paper a rece ntly-reported league table is scrutinized and the important methodolog ical features of the source studies identified. These include the choi ce of discount rate, the method of estimating utility values for healt h states, the range of costs and consequences considered and the choic e of comparison programme. Several recommendations are made for improv ements, both in the methodology of economic evaluation studies and in the construction and use of league tables. It is concluded that, for l eague tables to be useful, decision makers should be able to assess th e relevance and reliability of the evidence in their own setting. Full er reporting of methods and results by the authors of economic evaluat ion studies would greatly assist in the appropriate construction and u se of league tables.