Cost-effectiveness as a criterion for public spending on health: a reply to William Jack's 'second opinion'

Cost-effectiveness analysis (CEA) deals with the principal health effect th at enters any valuation of benefits, without the difficulty of moneterizing health gains or treating differences among individuals in how they value h ealth improvements. Much of Jack's criticism of CEA is based on misundersta nding of how it should be used. It is often an important criterion for dete rmining how to spend public money on health care, but never the only one, R easoning from the way individuals would choose to spend their own money amo ng different desirable effects, where CEA is not applicable or people do no t want the most cost-effective interventions. does not correspond to the pr oblems faced in allocating resources across individuals for the same purpos e. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.