TY - JOUR
T1 - Departures from cost-effectiveness recommendations
T2 - The impact of health system constraints on priority setting
AU - Hauck, Katharina
AU - Thomas, Ranjeeta
AU - Smith, Peter C.
PY - 2016/1/21
Y1 - 2016/1/21
N2 - The methods and application of cost-effectiveness analysis have reached an advanced stage of development. Many decision makers consider cost-effectiveness analysis (CEA) to be a valid and feasible approach toward setting health priorities, and it has been extensively applied in evaluating interventions and developing evidence-based clinical guidelines. However, the recommendations arising from cost-effectiveness analysis are often not implemented as intended. A fundamental reason for the failure to implement is that CEA assumes a single constraint, in the form of the budget constraint, whereas in reality decision makers may be faced with numerous other constraints. The objective of this article is to develop a typology of constraints that may act as barriers to implementation of cost-effectiveness recommendations. Six categories of constraints are considered: the design of the health system; costs of implementing change; system interactions between interventions; uncertainty in estimates of costs and benefits; weak governance; and political constraints. Where possible—and if applicable—for each class of constraint, the article discusses ways in which these constraints can be taken into account by a decision maker wishing to pursue the principles of cost-effectiveness.
AB - The methods and application of cost-effectiveness analysis have reached an advanced stage of development. Many decision makers consider cost-effectiveness analysis (CEA) to be a valid and feasible approach toward setting health priorities, and it has been extensively applied in evaluating interventions and developing evidence-based clinical guidelines. However, the recommendations arising from cost-effectiveness analysis are often not implemented as intended. A fundamental reason for the failure to implement is that CEA assumes a single constraint, in the form of the budget constraint, whereas in reality decision makers may be faced with numerous other constraints. The objective of this article is to develop a typology of constraints that may act as barriers to implementation of cost-effectiveness recommendations. Six categories of constraints are considered: the design of the health system; costs of implementing change; system interactions between interventions; uncertainty in estimates of costs and benefits; weak governance; and political constraints. Where possible—and if applicable—for each class of constraint, the article discusses ways in which these constraints can be taken into account by a decision maker wishing to pursue the principles of cost-effectiveness.
KW - Cost-effectiveness analysis
KW - Decision making
KW - Health technology assessment
KW - Implementation
KW - Priority setting
UR - http://www.scopus.com/inward/record.url?scp=85003235741&partnerID=8YFLogxK
U2 - 10.1080/23288604.2015.1124170
DO - 10.1080/23288604.2015.1124170
M3 - Article
AN - SCOPUS:85003235741
SN - 2328-8604
VL - 2
SP - 61
EP - 70
JO - Health Systems and Reform
JF - Health Systems and Reform
IS - 1
ER -