Paper of the week: 27.06.18

Muir Gray’s paper of the week: Cost effectiveness is necessary, but not sufficient

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Reference: Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions Helen Dakin and Alastair Gray. Medical Decision Making 2018, Vol. 38(4) 476–486 DOI: 10.1177/0272989X18758018

Bottom line, chosen by Muir from the paper

We demonstrated that making a joint decision on multiple interventions, considering interactions, will always maximize health gains from the budget, whereas making independent decisions on interacting technologies can lead to inefficient resource allocation decisions.

Implications for value improvement

This paper demonstrates clearly that the demonstration of cost effectiveness is necessary but not sufficient in assessing the value of an intervention. Archie Cochrane carried a banner in the 1930s, calling for ‘all effective treatments to be free’ but now we could not afford even all the cost-effective treatments.

An intervention has to be considered with respect to the added value it would bring to the people with a particular condition or characteristic in comparison with the value that would result if the resources were invested in another way – the opportunity value (1) rather than simply the cost effectiveness

(1) Opportunity Value. Muir Gray and Tom Porter. Journal of Health Services Research & Policy Vol 14, Issue 3, pp. 129 – 130 First Published July 11, 2017