Departures from cost-effectiveness recommendations: The impact of health system constraints on priority setting

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 -