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Economic Issues Simulation

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Economic Issues Simulation

Budget constraints increasingly determine the provision of health care services. One of the promises of cost-effectiveness analysis is that it can demonstrate how to maximize the health care benefits attainable within a specific budget.1,2 Despite this promise, cost-effectiveness analysis has been criticized for setting health care priorities in a way that violates people's values.3-5 For example, many people value equity in the distribution of health care resources, yet equity is not accounted for in cost-effectiveness analyses.6-13
A basic assumption of cost-effectiveness analysis is that one should always prefer a health care intervention that provides a population with more benefit per dollar than another intervention. However, sometimes budget constraints make it impossible to offer the most cost-effective intervention to everyone in the population, raising issues of equity.14 For example, suppose one has a fixed budget of $200,000 with which to screen a specific population for colon cancer. Test 1 costs $200,000 to offer to everyone in the population and prevents 1000 deaths from colon cancer. Test 2 costs $400,000 to offer to everyone and prevents 2200 deaths from colon cancer. Because of the budget, it is impossible to offer test 2 to everyone. However, it is possible to offer it to half the population, thereby exhausting the $200,000 budget and preventing 1100 deaths from colon cancer. Test 2 is more cost effective than test 1, because for the same number of dollars, it brings more benefit.

With restrictions placed on budgets, it is often impossible to offer the most cost-effective intervention to all the people who might benefit from it. Basing health care policies on cost effectiveness alone can lead to inequities or the appearance of inequities.

Conclusion

With restrictions placed on budgets, it is often impossible

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