State-of-the-Art Paper
Interpreting the Results of Cost-Effectiveness Studies

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In developed nations, health care spending is an increasingly important economic and political issue. The discipline of cost-effectiveness (CE) analysis has developed over several decades as a tool for objectively assessing the value of new medical strategies, by simultaneously examining incremental health benefits in light of incremental costs. The underlying goal of CE research is to allow clinicians and policymakers to make more rational decisions regarding clinical care and resource allocation. This review will provide the reader with an understanding of the theoretical underpinnings of CE analysis, the types of analyses commonly performed and reported in the medical literature, some important strengths and weaknesses of different analytical approaches, and key principles in the interpretation of CE results. Key principles reviewed include the impact of analytic perspective, the importance of proper incremental comparisons, the effect of time horizon, and methods for exploring and describing uncertainty. Illustrative examples from the cardiology literature are discussed.

Key Words

costs
cost-effectiveness
quality of life

Abbreviations and Acronyms

CE
cost-effectiveness
CRT-D
cardiac resynchronization therapy defibrillator
CRT-P
cardiac resynchronization therapy pacemaker
DES
drug-eluting stent(s)
iCER
incremental cost-effectiveness ratio
QALY
quality-adjusted life year

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Dr. Cohen reports grant support from Eli Lilly, Cordis, Boston Scientific, Bristol-Myers Squibb/Sanofi, The Medicines Company, and Edwards Lifesciences, as well as consulting fees from Medtronic. Dr. Reynolds is supported by grant K23 HL077171 from the National Heart, Lung, and Blood Institute and also reports grant support from Edwards Lifesciences and consulting fees from Biosense Webster, and Sanofi-Aventis.