Summary
There has been much recent debate in the health economics literature as to the (near) equivalence of cost—benefit analysis (CBA) and cost—effectiveness analysis (CEA). The aim of this paper is to demonstrate that whether such a (near) equivalence exists depends on whether one defines economic evaluations as ‘CBA’ or ‘CEA’ on the basis of either what is measured or what question the analyst is seeking to answer. The former basis of definition is popular within the ‘decision science’ approach to economic evaluation, but does not seem to have any theoretical support. If the latter, more theoretically correct, basis is accepted, there is no longer a case for the (near) equivalence of CBA and CEA.
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References
Maynard A. Economic evaluation techniques in healthcare. Pharmacoeconomics 1997; 11 (2): 115–8
Garber AM, Phelps CE. Economic foundations of cost—effectiveness analysis. J Health Econ 1997; 16: 1–31
Meltzer D. Accounting for future costs medical cost—effectiveness analysis. J Health Econ 1997; 16: 33–64
Phelps CE, Mushlin AI. On the (near) equivalence of costeffectiveness and cost—benefit analyses. Int J Technol Assess Health Care 1991; 7: 12–21
Mooney GH. Economic evaluation: the Australian road to health service efficiency. In: Health care evaluation — report of the National Health Care Evaluations Workshop, July 1989. Canberra: Public Health Association of Australia, 1989
Mishan EJ. Cost—benefit analysis. 4th ed. London: Unwin Hyman, 1988
Dreze J, Stern N. The theory of cost—benefit analysis. In: Auerbach AE, Feldstein M, editors. Handbook of public economics. Vol. II. Amsterdam: Elsevier Science Publishers, 1987
Johannesson M. The relationship between cost—effectiveness analysis and cost—benefits analysis. Soc Sci Med 1995; 41: 483–9
Drummond MF, Stoddart GL. Economic evaluation of health—producing technologies across different countries. Health Policy 1995; 33: 219–31
Donaldson C, Shackley P. Economic evaluation. In: Detels R, Holland WW, Mc Ewen J, et al., editors. Oxford textbook of public health. Vol. 2: the methods of public health. 3rd ed. Oxford: Oxford University Press, 1997: 849–71
Birch S, Donaldson C. Applications of cost benefit analysis to health care: departures from welfare economic theory. J Health Econ 1987; 6: 211–25
Culyer AJ. Economics. Oxford: Blackwell, 1985
Gould D. A groundling—s notebook. New Scient 1971; 51: 217
Gravelle H, Rees R. Microeconomics. London: Longman, 1981
Gold MR, Siegel JE, Russell LB, et al. Cost—effectiveness in health and medicine. New York: Oxford University Press, 1996
Drummond MF, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997
Russell IT, Devlin B, Fell M, et al. Day case surgery for hernias and haemorrhoids: a clinical, social and economic evaluation. Lancet 1977; I: 844–7
Doesell DP. Economic analysis and end stage renal disease: an Australian study. Econ Anal Policy 1978; 8: 21–36
Donaldson C, Mapp T, Farrar S, et al. Assessing community values in health care: is the ‘willingness to pay’ method feasible? Health Care Anal 1997; 5: 7–29
Luce BR, Simpson K. Methods of cost—effectiveness analysis: areas of consensus and debate. Clin Ther 1995; 17: 109–25
Freund DA, Dittus RS. Principles of pharmacoeconomic analysis of drug therapy. Pharmacoeconomics 1992; 1 (1): 20–9
Henry D. Economic analysis as an aid to subsidisation: the development of Australian guidelines for pharmaceuticals. Pharmacoeconomics 1992; 1 (1): 54–67
Kristiansen IS, Eggen AE, Thelle DS. Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worthwhile? BMJ 1991; 302: 1119–22
Johannesson M, Jonsson B, Kjekshus J, et al. Cost effectiveness of simvastatin treatment to lower cholesterol levels in patients with coronary heart disease. N Engl J Med 1997; 336: 332–6
Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995; 332: 1418–24
Birch S, Gafni A. Cost—effectiveness ratios: in a league of their own. Health Policy 1994; 28: 133–41
Ortega A, Dranitsaris G, Sturgeon J, et al. Cost—utility analysis of paclitaxel in combination with cisplatin for patients with advanced ovarian cancer. Gynecol Oncol 1997; 66: 454–63
Mc Guire W, Neugut AI, Arikian S, et al. Analysis of the cost effectiveness of paclitaxel as alternative combination therapy for advanced ovarian cancer. J Clin Oncol 1997; 15: 640–5
Elit LM, Gafni A, Levine MN. Economic and policy implications of adopting paclitaxel as first—line therapy for advanced ovarian cancer: an Ontario perspective. J Clin Oncol 1997; 15: 632–9
Gafni A, Birch S. Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditures and how to avoid the problem. Can Med Assoc J 1993; 148: 913–7
Birch S, Gafni A. Cost effectiveness/cost utility analyses: do current decision rules take us to where we want to be? J Health Econ 1992; 11: 279–96
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Donaldson, C. The (Near) Equivalence of Cost—Effectiveness and Cost-Benefit Analyses. Pharmacoeconomics 13, 389–396 (1998). https://doi.org/10.2165/00019053-199813040-00002
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DOI: https://doi.org/10.2165/00019053-199813040-00002