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Cost-effectiveness league tables: More harm than good?

Author

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  • Drummond, Michael
  • Torrance, George
  • Mason, James

Abstract

In recent years it has become fashionable to make comparisons (in 'league tables' or rankings) between health care interventions in terms of their relative cost-effectiveness, in cost per life-year or cost per quality-adjusted life-year gained. However, concerns have been raised about the unthinking use of league tables and some authors have questioned the theoretical basis of their construction. In this paper a recently-reported league table is scrutinized and the important methodological features of the source studies identified. These include the choice of discount rate, the method of estimating utility values for health states, the range of costs and consequences considered and the choice of comparison programme. Several recommendations are made for improvements, both in the methodology of economic evaluation studies and in the construction and use of league tables. It is concluded that, for league tables to be useful, decision makers should be able to assess the relevance and reliability of the evidence in their own setting. Fuller reporting of methods and results by the authors of economic evaluation studies would greatly assist in the appropriate construction and use of league tables.

Suggested Citation

  • Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
    • Handle: RePEc:eee:socmed:v:37:y:1993:i:1:p:33-40
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    Citations

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    Cited by:

    1. Tom Jefferson & Miranda Mugford & Alastair Gray & Vittorio Demicheli, 1996. "An exercise on the feasibility of carrying out secondary economic analyses," Health Economics, John Wiley & Sons, Ltd., vol. 5(2), pages 155-165, March.
    2. James Mason & Mike Drummond, 1995. "The DH register of cost-effectiveness studies: a review of study content and quality," Working Papers 128chedp, Centre for Health Economics, University of York.
    3. Debby Postulart & Eddy M.M. Adang, 2000. "Response Shift and Adaptation in Chronically III Patients," Medical Decision Making, , vol. 20(2), pages 186-193, April.
    4. Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost‐effectiveness results to decision‐makers," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 473-477, July.
    5. A. David Paltiel & Julie A. Scharfstein & George R. Seage & Elena Losina & Sue J. Goldie & Milton C. Weinstein & Donald E. Craven & Kenneth A. Freedberg, 1998. "A Monte Carlo Simulation of Advanced HIV Disease," Medical Decision Making, , vol. 18(2_suppl), pages 93-105, April.
    6. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
    7. Rutten, Frans, 1996. "Economic evaluation and health care decision-making," Health Policy, Elsevier, vol. 36(3), pages 215-229, June.
    8. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    9. Richard H. Chapman & Patricia W. Stone & Eileen A. Sandberg & Chaim Bell & Peter J. Neumann, 2000. "A Comprehensive League Table of Cost-Utility Ratios and a Sub-table of "Panel-worthy" Studies," Medical Decision Making, , vol. 20(4), pages 451-458, October.
    10. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    11. Phusit Prakongsai & Natasha Palmer & Preecha Uay-Trakul & Viroj Tangcharoensathien & Anne Mills, 2009. "The implications of benefit package design: the impact on poor Thai households of excluding renal replacement therapy," Journal of International Development, John Wiley & Sons, Ltd., vol. 21(2), pages 291-308.
    12. Joakim Ramsberg, 2002. "When should expenditure per life saved vary?," Journal of Risk Research, Taylor & Francis Journals, vol. 5(3), pages 249-263, July.
    13. Gafni, Amiram & Birch, Stephen, 2006. "Incremental cost-effectiveness ratios (ICERs): The silence of the lambda," Social Science & Medicine, Elsevier, vol. 62(9), pages 2091-2100, May.
    14. Peter J. Neumann & Darren E. Zinner & Janice C. Wright, 1997. "Are Methods for Estimating QALYs in Cost-Effectiveness Analyses Improving?," Medical Decision Making, , vol. 17(4), pages 402-408, October.
    15. Wolfgang C. Winkelmayer & Milton C. Weinstein & Murray A. Mittleman & Robert J. Glynn & Joseph S. Pliskin, 2002. "Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment," Medical Decision Making, , vol. 22(5), pages 417-430, October.
    16. Christopher J.L. Murray & David B. Evans & Arnab Acharya & Rob M.P.M. Baltussen, 2000. "Development of WHO guidelines on generalized cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 9(3), pages 235-251, April.
    17. Lindholm, Lars & Rosen, Mans & Emmelin, Maria, 1996. "An epidemiological approach towards measuring the trade-off between equity and efficiency in health policy," Health Policy, Elsevier, vol. 35(3), pages 205-216, March.
    18. Cookson, Richard & Hutton, John, 2003. "Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective," Health Policy, Elsevier, vol. 63(2), pages 167-178, February.
    19. Ann E. Clarke, 1997. "Arthritis Patient Education: How Economic Evaluations Can Inform Health Policy," Canadian Public Policy, University of Toronto Press, vol. 23(s1), pages 162-176, Spring.
    20. Andrew R. Willan & Bernie J. O'Brien, 1996. "Confidence intervals for cost‐effectiveness ratios: An application of Fieller's theorem," Health Economics, John Wiley & Sons, Ltd., vol. 5(4), pages 297-305, July.
    21. Drummond, Michael & Mason, James & Torrance, George, 1995. "Cost-effectiveness league tables: think of the fans," Health Policy, Elsevier, vol. 31(3), pages 231-238, March.

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