EVALUATING THE COST-EFFECTIVENESS OF CLINICAL AND PUBLIC-HEALTH MEASURES

Cost-effectiveness analysis, an analytic tool that expresses as a rati o the cost of obtaining an additional unit of health outcome, can help decision makers achieve more health protection for the same or less c ost. We characterize the state of the cost-effectiveness analysis lite rature by reviewing how this technique is applied to various clinical and public health interventions. We describe the results of cost-effec tiveness analyses for over 40 interventions to reduce cancer, heart di sease, trauma, and infectious disease. The cost-effectiveness ratios f or these interventions vary enormously, from interventions that save m oney to those that cost more than $1 million per year of life gained. The methods used to derive the cost-effectiveness ratios also vary con siderably, and we summarize this variation within each health area. Gr eater uniformity of analytical practice will be necessary if cost-effe ctiveness analysis is to became a more influential tool in debates abo ut resource allocation.