Ratio-based and net benefit-based approaches to health care resource allocation: Proofs of optimality and equivalence

Both incremental cost-effectiveness ratios and net benefits have been propo sed as summary measures for use in cost-effectiveness analyses. We present a unifying proof of the optimality and equivalence of ICER- and net benefit -based approaches to the health resource allocation problem, including both 'fixed budget' and 'fixed price' decision rules. If internally consistent willingness-to-pay values are used, ratio- and net benefit-based decision r ules identify the same optimal allocation. Because they have identical reso urce allocation implications, use of one or other of the two approaches mus t be based on other criteria, such as their behaviour under conditions of u ncertainty. Copyright (C) 1999 John Wiley & Sons, Ltd.