COST-BENEFIT ANALYSES IN THE HEALTH-CARE LITERATURE - DONT JUDGE A STUDY BY ITS LABEL

Objectives: To assess whether health care related economic evaluations labeled as ''cost benefit analyses'' (CBA) meet a contemporary defini tion of CBA methodology and to assess the prevalence of methods used f ur assigning monetary units to health outcomes. Data Sources: Medline, Current Contents, and HSTAR databases and reference lists of review a rticles, 1991-1995. Study Selection: Economic analyses labeled as CBAs were included. Agreement on study selection was assessed. Study Evalu ation: CBA studies were classified according to standard definitions o f economic analytical tech techniques. For those valuing health outcom es in monetary units (bona fide CBAs), the method of valuation was cla ssified. Results: 53% of 95 studies were reclassified as cost comparis ons because health outcomes were not appraised. Among the 32% consider ed bona fide CBAs, the human capital approach was employed to value he alth states in monetary units in 70%. Contingent valuation methods wer e employed infrequently (13%). Conclusions: Studies labeled as CBAs in the health-care literature often offer only partial program evaluatio n. Decisions based only on resource costs are unlikely to improve effi ciency in resource allocation. Among bona fide CBAs, the human capital approach was most commonly used to valuing health, despite its limita tions. The results of health-care related CBAs should De interpreted w ith extreme caution. (C) 1997 Elsevier Science Inc.