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Economic evaluation to inform health care decision-making: Promise, pitfalls and a proposal for an alternative path


  • Brousselle, Astrid
  • Lessard, Chantale


Health economic evaluation aims at providing information on the efficiency of interventions. Since the 1980s, there have been major developments in the field, especially in terms of methodologies. As the field has expanded and developed, methodologies have become increasingly sophisticated. In parallel, over the past decade, the conduct of economic evaluations has become more and more institutionalized with, among other things, the creation of the National Institute for Health and Clinical Excellence (NICE) in England and Wales and a growing number of health technology assessment (HTA) agencies around the world. Yet the literature has identified important barriers to the use of economic evaluation in decision-making, among them the difficulty of deciphering economic evaluation research. The way the field expanded has thus created a paradox: whereas economic evaluation is seen as an insightful tool for achieving efficiency in health care, its methodological developments have decreased decision-makers' capacity to use it. In this paper, based on a literature survey, we explore this shift by first analyzing how the field of economic evaluation has developed in recent years. Second, we discuss how economic evaluation information is perceived and used in decision-making. Third, we consider a possible direction for reconciling economic evaluation and decision-making. The originality of this article is that it not only highlights the increasing gap between the aim of economic evaluation and its effective use in decision-making but also proposes, based on existing methodologies, a competing approach to the currently dominant paradigm.

Suggested Citation

  • Brousselle, Astrid & Lessard, Chantale, 2011. "Economic evaluation to inform health care decision-making: Promise, pitfalls and a proposal for an alternative path," Social Science & Medicine, Elsevier, vol. 72(6), pages 832-839, March.
  • Handle: RePEc:eee:socmed:v:72:y:2011:i:6:p:832-839

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    References listed on IDEAS

    1. Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial-based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    3. N. J. Cooper & A. J. Sutton & A. E. Ades & S. Paisley & D. R. Jones, 2007. "Use of evidence in economic decision models: practical issues and methodological challenges," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1277-1286.
    4. Lessard, Chantale, 2007. "Complexity and reflexivity: Two important issues for economic evaluation in health care," Social Science & Medicine, Elsevier, vol. 64(8), pages 1754-1765, April.
    5. Pinkerton, Steven D. & Johnson-Masotti, Ana P. & Derse, Arthur & Layde, Peter M., 2002. "Ethical issues in cost-effectiveness analysis," Evaluation and Program Planning, Elsevier, vol. 25(1), pages 71-83, February.
    6. Kalipso Chalkidou & Anthony Culyer & Bhash Naidoo & Peter Littlejohns, 2008. "Cost-effective public health guidance: asking questions from the decision-maker's viewpoint," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 441-448.
    7. Eddama, Oya & Coast, Joanna, 2008. "A systematic review of the use of economic evaluation in local decision-making," Health Policy, Elsevier, vol. 86(2-3), pages 129-141, May.
    8. Lessard, Chantale & Contandriopoulos, André-Pierre & Beaulieu, Marie-Dominique, 2010. "The role (or not) of economic evaluation at the micro level: Can Bourdieu's theory provide a way forward for clinical decision-making?," Social Science & Medicine, Elsevier, vol. 70(12), pages 1948-1956, June.
    9. Hadorn, David C., 1991. "The role of public values in setting health care priorities," Social Science & Medicine, Elsevier, vol. 32(7), pages 773-781, January.
    10. Eddama, Oya & Coast, Joanna, 2009. "Use of economic evaluation in local health care decision-making in England: A qualitative investigation," Health Policy, Elsevier, vol. 89(3), pages 261-270, March.
    11. Al, Maiwenn J. & Feenstra, Talitha & Brouwer, Werner B. F., 2004. "Decision makers' views on health care objectives and budget constraints: results from a pilot study," Health Policy, Elsevier, vol. 70(1), pages 33-48, October.
    12. Sassi, Franco, 2003. "Setting priorities for the evaluation of health interventions: when theory does not meet practice," Health Policy, Elsevier, vol. 63(2), pages 141-154, February.
    13. Badia, Xavier & Roset, Monserrat & Herdman, Michael, 1999. "Inconsistent responses in three preference-elicitation methods for health states," Social Science & Medicine, Elsevier, vol. 49(7), pages 943-950, October.
    14. McKie, John & Richardson, Jeff, 2003. "The Rule of Rescue," Social Science & Medicine, Elsevier, vol. 56(12), pages 2407-2419, June.
    15. 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.
    16. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
    17. Bleichrodt, Han & Johannesson, Magnus, 1997. "Standard gamble, time trade-off and rating scale: Experimental results on the ranking properties of QALYs," Journal of Health Economics, Elsevier, vol. 16(2), pages 155-175, April.
    18. Dobrow, Mark J. & Goel, Vivek & Upshur, R. E. G., 2004. "Evidence-based health policy: context and utilisation," Social Science & Medicine, Elsevier, vol. 58(1), pages 207-217, January.
    19. Emmett B. Keeler & Shan Cretin, 1983. "Discounting of Life-Saving and Other Nonmonetary Effects," Management Science, INFORMS, vol. 29(3), pages 300-306, March.
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    Cited by:

    1. Walton, Mat, 2014. "Applying complexity theory: A review to inform evaluation design," Evaluation and Program Planning, Elsevier, vol. 45(C), pages 119-126.
    2. repec:spr:pharme:v:35:y:2017:i:4:d:10.1007_s40273-016-0477-x is not listed on IDEAS
    3. Elias Asfaw Zegeye & Josue Mbonigaba & Sylvia Blanche Kaye & Thomas Wilkinson, 2017. "Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers," Applied Health Economics and Health Policy, Springer, vol. 15(1), pages 33-43, February.
    4. repec:spr:eujhec:v:18:y:2017:i:6:d:10.1007_s10198-016-0823-0 is not listed on IDEAS
    5. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39.
    6. Alexei Botchkarev, 2016. "Toward Development of a New Health Economic Evaluation Definition," Papers 1608.01891,
    7. Fernando Antoñanzas & Robert Terkola & Maarten Postma, 2016. "The Value of Medicines: A Crucial but Vague Concept," PharmacoEconomics, Springer, vol. 34(12), pages 1227-1239, December.
    8. Cheung, Kei Long & Evers, Silvia M.A.A. & Hiligsmann, Mickaël & Vokó, Zoltán & Pokhrel, Subhash & Jones, Teresa & Muñoz, Celia & Wolfenstetter, Silke B. & Józwiak-Hagymásy, Judit & de Vries, Hein, 2016. "Understanding the stakeholders’ intention to use economic decision-support tools: A cross-sectional study with the tobacco return on investment tool," Health Policy, Elsevier, vol. 120(1), pages 46-54.


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