Personal paper: how to get the best health outcome for a given amount of money

Introduction

Increasingly, healthcare programmes are evaluated in terms of both their costs and outcomes. However, existing evaluation designs, in which equal numbers of participants are compared, remain a hangover from the time when outcomes were the sole concern. Outcome maximisation studies, in which costs are equalised, are an alternative way of comparing the costs and consequences of health interventions. They may be feasible in some instances and are attractive because they highlight two of the main messages of health economics.

Firstly, economists emphasise that their concern for the costs of interventions is due to the implications of opportunity costs—that is, resources used for one intervention should be compared with the potential benefits achievable by the next best option that is forgone because the resources for health care are finite.1 2 3 In an outcome maximisation design the opportunity costs of high cost interventions would be highlighted more clearly in the study results.

Secondly, the marginal costs of implementing programmes do not necessarily equal average costs, in which marginal costs are the change in costs resulting from a small change in the level of provision.4 By evaluating alternative technologies at comparable levels of expenditure, outcome maximisation studies would take account of the fact that programme costs often do not rise proportionally with the number of patients treated.