Skip to main content
Erschienen in: PharmacoEconomics 11/2006

01.11.2006 | Conference Paper

Information Created to Evade Reality (ICER)

Things We Should Not Look to for Answers

verfasst von: Dr Stephen Birch, Amiram Gafni

Erschienen in: PharmacoEconomics | Ausgabe 11/2006

Einloggen, um Zugang zu erhalten

Abstract

Cost-effectiveness analysis has been advocated in the health economics methods literature and adopted in a growing number of jurisdictions as an evidence base for decision makers charged with maximising health gains from available resources.
This paper critically appraises the information generated by cost-effectiveness analysis, in particular the incremental cost-effectiveness ratio (ICER). It is shown that this ratio is used as comparative information on what are non-comparable options and hence evades the reality of the decision-maker’s problem. The theoretical basis for the ICER approach is the simplification of theoretical assumptions that have no relevance to the decision maker’s context. Although alternative, well established methods can be used for addressing the decision maker’s problem, faced with the increasing evidence of the theoretical and empirical failures of the cost-effectiveness approach, some proponents of the approach now propose changing the research question to suit the approach as opposed to adopting a more appropriate method for the prevailing and continuing problem.
As long as decision makers are concerned with making the best use of available healthcare resources, cost-effectiveness analysis and the ICER should not be where we look for answers.
Fußnoten
1
The use of trade names is for product identification purposes only and does not imply endorsement.
 
Literatur
1.
Zurück zum Zitat Henry D. Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals. Pharmacoeconomics 1992; 1: 54–67PubMedCrossRef Henry D. Economic analysis as an aid to subsidisation decisions: the development of Australian guidelines for pharmaceuticals. Pharmacoeconomics 1992; 1: 54–67PubMedCrossRef
2.
Zurück zum Zitat National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence, 2004 National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: National Institute for Clinical Excellence, 2004
3.
Zurück zum Zitat Canadian Agency for Drugs and Technologies in Health. Guidelines for the economic evaluation of health technologies. 3rd ed. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2006 Canadian Agency for Drugs and Technologies in Health. Guidelines for the economic evaluation of health technologies. 3rd ed. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health, 2006
4.
Zurück zum Zitat Ubel P, Hirth R, Chernew M, et al. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med 2003; 163: 1637–1641PubMedCrossRef Ubel P, Hirth R, Chernew M, et al. What is the price of life and why doesn’t it increase at the rate of inflation? Arch Intern Med 2003; 163: 1637–1641PubMedCrossRef
5.
Zurück zum Zitat Birch S, Gafni A. The ‘NICE’ approach to technology assessment: an economics perspective. Health Care Manag Sci 2004; 7: 35–41PubMedCrossRef Birch S, Gafni A. The ‘NICE’ approach to technology assessment: an economics perspective. Health Care Manag Sci 2004; 7: 35–41PubMedCrossRef
6.
Zurück zum Zitat Gold M, Siegel J, Russell L, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996 Gold M, Siegel J, Russell L, et al. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996
7.
Zurück zum Zitat Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2005 Drummond M, Sculpher M, Torrance G, et al. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 2005
8.
Zurück zum Zitat Claxton K, Sculpher M, Culyer A, et al. Discounting and cost-effectiveness in NICE: stepping back to sort out a confusion. Health Econ 2006; 15: 1–4PubMedCrossRef Claxton K, Sculpher M, Culyer A, et al. Discounting and cost-effectiveness in NICE: stepping back to sort out a confusion. Health Econ 2006; 15: 1–4PubMedCrossRef
9.
Zurück zum Zitat Gafni A, Birch S. Incremental cost effectiveness ratios (ICERs): the silence of the lambda. Soc Sci Med 2006; 62: 2091–2100PubMedCrossRef Gafni A, Birch S. Incremental cost effectiveness ratios (ICERs): the silence of the lambda. Soc Sci Med 2006; 62: 2091–2100PubMedCrossRef
10.
Zurück zum Zitat Culyer A. Ought NICE to have a cost-effectiveness threshold? In: Towse A, Pritchard C, Devlin N, editors. Cost-effectiveness thresholds: economic and ethical issues. London: Kings Fund and Office of Health Economics, 2002: 9–14 Culyer A. Ought NICE to have a cost-effectiveness threshold? In: Towse A, Pritchard C, Devlin N, editors. Cost-effectiveness thresholds: economic and ethical issues. London: Kings Fund and Office of Health Economics, 2002: 9–14
11.
Zurück zum Zitat Rawlins M, Culyer A. National Institute for Clinical Excellence and its value judgements. BMJ 2004; 329: 224–227PubMedCrossRef Rawlins M, Culyer A. National Institute for Clinical Excellence and its value judgements. BMJ 2004; 329: 224–227PubMedCrossRef
12.
Zurück zum Zitat Williams A. What could be nicer than NICE? London: Office of Health Economics, 2004 Williams A. What could be nicer than NICE? London: Office of Health Economics, 2004
13.
Zurück zum Zitat Birch S, Gafni A. The biggest bang for the buck or bigger bucks for the bang: the fallacy of the cost-effectiveness threshold. J Health Serv Res Policy 2006; 11: 46–51PubMedCrossRef Birch S, Gafni A. The biggest bang for the buck or bigger bucks for the bang: the fallacy of the cost-effectiveness threshold. J Health Serv Res Policy 2006; 11: 46–51PubMedCrossRef
14.
Zurück zum Zitat Laupacis A, Feeny D, Detsky A, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992; 146: 473–481PubMed Laupacis A, Feeny D, Detsky A, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. CMAJ 1992; 146: 473–481PubMed
15.
Zurück zum Zitat Lorinc J. How much are drugs worth? A fledgling medical science attempts an answer. University of Toronto Magazine [online]. Available from URL: http://www.magazine.utoronto.ca/06Spring/drugs.asp [Accessed 2006 Apr 25] Lorinc J. How much are drugs worth? A fledgling medical science attempts an answer. University of Toronto Magazine [online]. Available from URL: http://​www.​magazine.​utoronto.​ca/​06Spring/​drugs.​asp [Accessed 2006 Apr 25]
16.
Zurück zum Zitat Weinstein M, Zeckhauser R. Critical ratios and efficient allocation. J Public Econ 1973; 2: 147–157CrossRef Weinstein M, Zeckhauser R. Critical ratios and efficient allocation. J Public Econ 1973; 2: 147–157CrossRef
17.
Zurück zum Zitat Gafni A, Birch S. Inclusion of drugs in provincial benefit programs: should ‘reasonable decisions’ lead to uncontrolled growth in expenditures? CMAJ 2003; 168: 849–851PubMed Gafni A, Birch S. Inclusion of drugs in provincial benefit programs: should ‘reasonable decisions’ lead to uncontrolled growth in expenditures? CMAJ 2003; 168: 849–851PubMed
18.
Zurück zum Zitat Devlin N. An introduction to the use of cost-effectiveness thresholds in decision making: what are the issues? In: Towse A, Pritchard C, Devlin N, editors. Cost-effectiveness thresholds: economic and ethical issues. London: Kings Fund and Office of Health Economics, 2002: 16–24 Devlin N. An introduction to the use of cost-effectiveness thresholds in decision making: what are the issues? In: Towse A, Pritchard C, Devlin N, editors. Cost-effectiveness thresholds: economic and ethical issues. London: Kings Fund and Office of Health Economics, 2002: 16–24
19.
Zurück zum Zitat Birch S, Gafni A. Changing the problem to fit the solution: Johannesson and Weinstein’s (mis)application of economics to real world problems. J Health Econ 1993; 12: 469–476PubMedCrossRef Birch S, Gafni A. Changing the problem to fit the solution: Johannesson and Weinstein’s (mis)application of economics to real world problems. J Health Econ 1993; 12: 469–476PubMedCrossRef
20.
Zurück zum Zitat Birch S, Gafni A. Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results. Health Policy 2003; 64: 207–219PubMedCrossRef Birch S, Gafni A. Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results. Health Policy 2003; 64: 207–219PubMedCrossRef
21.
Zurück zum Zitat Sendi P, Gafni A, Birch S. Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Econ 2002; 11: 23–32PubMedCrossRef Sendi P, Gafni A, Birch S. Opportunity costs and uncertainty in the economic evaluation of health care interventions. Health Econ 2002; 11: 23–32PubMedCrossRef
22.
Zurück zum Zitat Birch S, Gafni A. Cost-effectiveness/utility analyses: do current decision rules lead us to where we want to be? J Health Econ 1992; 11: 279–296PubMedCrossRef Birch S, Gafni A. Cost-effectiveness/utility analyses: do current decision rules lead us to where we want to be? J Health Econ 1992; 11: 279–296PubMedCrossRef
23.
Zurück zum Zitat Gafni A, Birch S. NICE methodological guidelines and decision making in the National Health Service in England and Wales. Pharmacoeconomics 2003; 21: 149–157PubMedCrossRef Gafni A, Birch S. NICE methodological guidelines and decision making in the National Health Service in England and Wales. Pharmacoeconomics 2003; 21: 149–157PubMedCrossRef
24.
Zurück zum Zitat Doubilet P, Weinstein M, McNeil B. Use and misuse of the term ‘cost effective’ in medicine. N Engl J Med 1986; 314: 253–256PubMedCrossRef Doubilet P, Weinstein M, McNeil B. Use and misuse of the term ‘cost effective’ in medicine. N Engl J Med 1986; 314: 253–256PubMedCrossRef
25.
Zurück zum Zitat Cookson R, McDaid D, Maynard A. Wrong SIGN, NICE mess: is national guidance distorting allocation of resources? BMJ 2001; 323: 743–745PubMedCrossRef Cookson R, McDaid D, Maynard A. Wrong SIGN, NICE mess: is national guidance distorting allocation of resources? BMJ 2001; 323: 743–745PubMedCrossRef
26.
Zurück zum Zitat Weinstein M. Decision rules for incremental cost-effectiveness analysis. In: Jones A, editor. The Elgar companion to health economics. Northampton: Edward Elgar, 2006: 469–478 Weinstein M. Decision rules for incremental cost-effectiveness analysis. In: Jones A, editor. The Elgar companion to health economics. Northampton: Edward Elgar, 2006: 469–478
27.
Zurück zum Zitat Birch S, Gafni A. Decision rules in economic evaluation. In: Jones A, editor. The Elgar companion to health economics. Northampton: Edward Elgar, 2006: 492–502 Birch S, Gafni A. Decision rules in economic evaluation. In: Jones A, editor. The Elgar companion to health economics. Northampton: Edward Elgar, 2006: 492–502
28.
Zurück zum Zitat Torrance G, Thomas W, Sackett D. A utility maximization model for evaluation of health care programmes. Health Serv Res 1972; 7: 118–133PubMed Torrance G, Thomas W, Sackett D. A utility maximization model for evaluation of health care programmes. Health Serv Res 1972; 7: 118–133PubMed
29.
Zurück zum Zitat Chen M, Bush J. Maximizing health system output with political and administrative constraints using mathematical programming. Inquiry 1976; 13: 215–227PubMed Chen M, Bush J. Maximizing health system output with political and administrative constraints using mathematical programming. Inquiry 1976; 13: 215–227PubMed
30.
Zurück zum Zitat Drummond M. Principles of economic appraisal in health care. Oxford: Oxford University Press, 1980 Drummond M. Principles of economic appraisal in health care. Oxford: Oxford University Press, 1980
31.
Zurück zum Zitat Drummond M, Torrance G, Mason J. Cost-effectiveness league tables: more harm than good? Soc Sci Med 1993; 37: 33–40PubMedCrossRef Drummond M, Torrance G, Mason J. Cost-effectiveness league tables: more harm than good? Soc Sci Med 1993; 37: 33–40PubMedCrossRef
32.
Zurück zum Zitat Mason J, Drummond M, Torrance G. Some guidelines on the use of cost effectiveness league tables. BMJ 1993; 306: 570–572PubMedCrossRef Mason J, Drummond M, Torrance G. Some guidelines on the use of cost effectiveness league tables. BMJ 1993; 306: 570–572PubMedCrossRef
33.
Zurück zum Zitat Birch S, Donaldson C. Applications of cost-benefit analysis to health care: departures from welfare economic theory. J Health Econ 1987; 6: 61–72CrossRef Birch S, Donaldson C. Applications of cost-benefit analysis to health care: departures from welfare economic theory. J Health Econ 1987; 6: 61–72CrossRef
34.
Zurück zum Zitat Stinnett A, Paltiel D. Mathematical programming for the efficient allocation of health care resources. J Health Econ 1996; 15: 641–653PubMedCrossRef Stinnett A, Paltiel D. Mathematical programming for the efficient allocation of health care resources. J Health Econ 1996; 15: 641–653PubMedCrossRef
35.
Zurück zum Zitat Gafni A, Birch S. Guidelines for the adoption of new technology: a potential prescription for uncontrolled growth in expenditures and how to avoid it. CMAJ 1993; 148: 913–924PubMed Gafni A, Birch S. Guidelines for the adoption of new technology: a potential prescription for uncontrolled growth in expenditures and how to avoid it. CMAJ 1993; 148: 913–924PubMed
36.
Zurück zum Zitat Fuchs V. Who shall live? Health, economics and social choice. New York: Basic Books, 1974 Fuchs V. Who shall live? Health, economics and social choice. New York: Basic Books, 1974
37.
Zurück zum Zitat Neumann P, Rosen A, Weinstein M. Medicare and cost-effectiveness analysis. N Engl J Med 2005; 353: 1516–1522PubMedCrossRef Neumann P, Rosen A, Weinstein M. Medicare and cost-effectiveness analysis. N Engl J Med 2005; 353: 1516–1522PubMedCrossRef
ai]38.
Zurück zum Zitat Smith R. The triumph of NICE. BMJ 2004 [online]. Available from URL: http://bmj.bmjjournals.com/cgi/content/full/329/7459/0g [Accessed 2006 May 5] Smith R. The triumph of NICE. BMJ 2004 [online]. Available from URL: http://​bmj.​bmjjournals.​com/​cgi/​content/​full/​329/​7459/​0g [Accessed 2006 May 5]
39.
Zurück zum Zitat Stinnett A, Mullahy J. Net health benefit: a new framework for the analysis of uncertainty in cost effectiveness analysis. Med Decis Making 1998; 18: S68–S80PubMedCrossRef Stinnett A, Mullahy J. Net health benefit: a new framework for the analysis of uncertainty in cost effectiveness analysis. Med Decis Making 1998; 18: S68–S80PubMedCrossRef
40.
Zurück zum Zitat Van Hout B, Al M, Gordon G, et al. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ 1994; 3: 309–319PubMedCrossRef Van Hout B, Al M, Gordon G, et al. Costs, effects and C/E-ratios alongside a clinical trial. Health Econ 1994; 3: 309–319PubMedCrossRef
41.
Zurück zum Zitat Briggs A. A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 1999; 8: 257–261PubMedCrossRef Briggs A. A Bayesian approach to stochastic cost-effectiveness analysis. Health Econ 1999; 8: 257–261PubMedCrossRef
42.
Zurück zum Zitat Dowie J. Why cost effectiveness should trump (clinical) effectiveness: the ethical economics of the South West quadrant. Health Econ 2004; 13: 453–460PubMedCrossRef Dowie J. Why cost effectiveness should trump (clinical) effectiveness: the ethical economics of the South West quadrant. Health Econ 2004; 13: 453–460PubMedCrossRef
43.
Zurück zum Zitat Briggs A, O’Brien B, Blackhause G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Ann Rev Public Health 2002; 23: 377–401CrossRef Briggs A, O’Brien B, Blackhause G. Thinking outside the box: recent advances in the analysis and presentation of uncertainty in cost-effectiveness studies. Ann Rev Public Health 2002; 23: 377–401CrossRef
44.
Zurück zum Zitat Claxton K, Posnett J. An economic approach to clinical trial design and research priority setting. Health Econ 1996; 5: 513–524PubMedCrossRef Claxton K, Posnett J. An economic approach to clinical trial design and research priority setting. Health Econ 1996; 5: 513–524PubMedCrossRef
45.
Zurück zum Zitat Claxton K. The irrelevance of inference: a decision making approach to the stochastic evaluation of health care technologies. J Health Econ 1999; 18: 342–364CrossRef Claxton K. The irrelevance of inference: a decision making approach to the stochastic evaluation of health care technologies. J Health Econ 1999; 18: 342–364CrossRef
46.
Zurück zum Zitat Sendi P, Briggs A. Affordability and cost effectiveness: decision-making on the cost-effectiveness plane. Health Econ 2001; 10: 675–680PubMedCrossRef Sendi P, Briggs A. Affordability and cost effectiveness: decision-making on the cost-effectiveness plane. Health Econ 2001; 10: 675–680PubMedCrossRef
47.
Zurück zum Zitat Baltussen R, Adam T, Tan-Torres Edejer T, et al. What is generalized cost-effectiveness analysis? In: Tan-Torres Edejer T, Baltussen R, Adam T, et al., editors. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization, 2003: 3–15 Baltussen R, Adam T, Tan-Torres Edejer T, et al. What is generalized cost-effectiveness analysis? In: Tan-Torres Edejer T, Baltussen R, Adam T, et al., editors. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization, 2003: 3–15
48.
Zurück zum Zitat Sculpher M, Claxton K, Akehurst R. Its just evaluation for decision making: recent developments in, and challenges for, cost-effectiveness research. In: Smith P, Ginelly L, Sculpher M, editors. Health policy and economics: opportunities and challenges. Milton Keynes: Open University Press, 2004: 8–41 Sculpher M, Claxton K, Akehurst R. Its just evaluation for decision making: recent developments in, and challenges for, cost-effectiveness research. In: Smith P, Ginelly L, Sculpher M, editors. Health policy and economics: opportunities and challenges. Milton Keynes: Open University Press, 2004: 8–41
49.
Zurück zum Zitat Mayor S. News extra: NICE estimates that its recommendations have cost the NHS £575m. BMJ 2002; 325: 924CrossRef Mayor S. News extra: NICE estimates that its recommendations have cost the NHS £575m. BMJ 2002; 325: 924CrossRef
50.
Zurück zum Zitat Maynard A, Bloor K, Freemantle N. Challenges for the National Institute for Clinical Excellence. BMJ 2004; 32: 227–229CrossRef Maynard A, Bloor K, Freemantle N. Challenges for the National Institute for Clinical Excellence. BMJ 2004; 32: 227–229CrossRef
Metadaten
Titel
Information Created to Evade Reality (ICER)
Things We Should Not Look to for Answers
verfasst von
Dr Stephen Birch
Amiram Gafni
Publikationsdatum
01.11.2006
Verlag
Springer International Publishing
Erschienen in
PharmacoEconomics / Ausgabe 11/2006
Print ISSN: 1170-7690
Elektronische ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200624110-00008

Weitere Artikel der Ausgabe 11/2006

PharmacoEconomics 11/2006 Zur Ausgabe