MAKING ECONOMIC EVALUATIONS RESPECTABLE

Policy-makers worldwide are on a quest to control national spending fo r health care and to enhance the value received for whatever is being spent on health care. One should think that the economic evaluation of clinical practice would play a major role in this quest. Alas, so far it has not, in spite of considerable progress in the development of s uitable methodology for such evaluations. The central point of this pa per is that the sheer conceptual and practical complexities of economi c evaluations in this context are not the only and possibly not the ma jor barrier to a more widespread use of this type of analysis. Just as important may be the suspicion among lay persons that such analyses a re easily driven by the assumptions the analyst packages into the anal ysis which, in turn, opens economic evaluation to hidden bias toward f avored results. It is proposed in this paper that this particular barr ier to the use of economic evaluations in health policy could be overc ome if these analyses were more routinely subjected to the rigorous an d penetrating audits that are customary in financial accounting. Typic ally, reserach papers in economics are audited through peer review onl y as to the methodology employed. The suggestions here is that a prope r, respectable audit ought to penetrate all the way to the data that w ere used to produce the findings in a study. The paper concludes with some suggestions on how to develop such an audit infrastructure. (C) 1 997 Elsevier Science Ltd.