Stanford Health Policy is a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine
FSI’s researchers assess health and medicine through the lenses of economics, nutrition and politics. They’re studying and influencing public health policies of local and national governments and the roles that corporations and nongovernmental organizations play in providing health care around the world. Scholars look at how governance affects citizens’ health, how children’s health care access affects the aging process and how to improve children’s health in Guatemala and rural China. They want to know what it will take for people to cook more safely and breathe more easily in developing countries.
FSI professors investigate how lifestyles affect health. What good does gardening do for older Americans? What are the benefits of eating organic food or growing genetically modified rice in China? They study cost-effectiveness by examining programs like those aimed at preventing the spread of tuberculosis in Russian prisons. Policies that impact obesity and undernutrition are examined; as are the public health implications of limiting salt in processed foods and the role of smoking among men who work in Chinese factories. FSI health research looks at sweeping domestic policies like the Affordable Care Act and the role of foreign aid in affecting the price of HIV drugs in Africa.
A unique, in-depth discussion of the uses and conduct of cost-effectiveness analyses (CEAs) as decision-making aids in the health and medical fields, Cost-Effectiveness in Health and Medicine is the product of over two years of comprehensive research and deliberation by a multi-disciplinary panel of economists, ethicists, psychometricians, and clinicians. Exploring cost-effectiveness in the context of societal decision-making for resource allocation purposes, this volume proposes that analysts include a "reference-case" analysis in all CEAs designed to inform resource allocation and puts forth the most explicit set of guidelines (together with their rationale) ever defined on the conduct of CEAs. Important theoretical and practical issues encountered in measuring costs and effectiveness, evaluating outcomes, discounting, and dealing with uncertainty are examined in separate chapters. Additional chapters on framing and reporting of CEAs elucidate the purpose of the analysis and the effective communication of its findings.
Cost-Effectiveness in Health and Medicine differs from the available literature in several important aspects. Most importantly, it represents a consensus on standard methods. Standardization is particularly important for CEA, since its principal goal, only partly realized to date, is to permit comparisons of the costs and health outcomes of alternative ways of improving health. The second major contribution of this book is the detailed level at which the discussion is offered. Guidelines in journal literature and in CEA-related books tend to be rather general, to the extent that the analyst is left with little guidance on specific matters. Thirdly, this volume is differentiated by a detailed discussion of the theoretical background underlying areas of controversy and the implications of methodological alternatives. Finally, the study is written with a wider audience in mind, since it is not limited , for instance, to pharmaceutical analysts, physicians or any other interest subgroup. Intended primarily for analysts in medicine and public health who wish to improve practice and comparability of CEAs, this book will also be of interest to decision-makers in government, managed care, and industry who wish to consider the roles and limitations of CEA and become familiar with the criteria for evaluating these studies.
For the American College of Physicians
OBJECTIVE: This review builds on the innovative research synthesis of Holder and his colleagues, addresses some of the limitations of the box-score approach to assessing treatment effectiveness that they used and provides a second approximation of the cost-effectiveness of treatment for alcoholism.
METHOD: For each of 141 comparative treatment studies, we determined whether or not it found at least one statistically significant positive effect on a drinking-related outcome variable for each of the modalities examined in a paired contrast with one other condition. We next calculated the predicted probability of each study yielding at least one statistically significant treatment effect, based on the number of tests for treatment effects conducted. Following that, for each study of a particular treatment modality, the strength of the "weakest competitor" against which the modality had been compared was determined. For each modality, we used the average predicted probability of the relevant studies finding a significant effect and the average effectiveness of the weakest competitor to predict the modality's effectiveness.
RESULTS: We calculated an Adjusted Effectiveness Index (AEIn) for each modality, which was the difference between its predicted and actual effectiveness score. Our AEIn results were consistent with those of Holder et al. in suggesting that some of the same modalities appear to be effective or ineffective. Our results differed from their findings with respect to other modalities, however. Using data presented by Holder and his colleagues on the minimum estimated cost of providing different modalities, we offer a second approximation of the modalities' cost-effectiveness.
CONCLUSIONS: Overall, we found a smaller range of effectiveness across modalities than did Holder and his colleagues and a nonsignificant relationship between cost and effectiveness. Like Holder et al., we do not believe major treatment provision or funding decisions should be based solely on this type of review.