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Non-linearity in the cost-effectiveness frontier


  • Joanne Lord

    (National Institute for Health and Clinical Excellence (NICE), London, UK)

  • George Laking

    (Cancer Research-UK PET Oncology Group, Manchester Molecular Imaging Centre, Christie Hospital, UK)

  • Alastair Fischer

    (Department of Community Health Sciences, St. George's University of London, London, UK)


Conventional cost-effectiveness decision rules rely on the assumptions that all health care programmes are divisible and exhibit constant returns to scale for a homogeneous population; hence, the path between adjacent programmes on a cost-effectiveness frontier must be linear. In this paper we build a framework to analyse non-linear 'expansion' paths. We model the impact of two key sources of non-linearity: economies of scale or scope in the production of health care; and prioritisation of patients who are most likely to benefit from more expensive and more effective treatments. We conclude that the expansion path might be linear, convex or concave, depending on the situation. The path might also exhibit vertical discontinuity due to fixed costs or horizontal discontinuity due to indivisibility. The efficiency of resource allocation might be improved by empirical estimation of expansion paths. We discuss the advantages and disadvantages of this approach compared with a standard stratified analysis. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • Joanne Lord & George Laking & Alastair Fischer, 2006. "Non-linearity in the cost-effectiveness frontier," Health Economics, John Wiley & Sons, Ltd., vol. 15(6), pages 565-577.
  • Handle: RePEc:wly:hlthec:v:15:y:2006:i:6:p:565-577 DOI: 10.1002/hec.1083

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    References listed on IDEAS

    1. Alvarez, Luis H. R. & Stenbacka, Rune, 2001. "Adoption of uncertain multi-stage technology projects: a real options approach," Journal of Mathematical Economics, Elsevier, vol. 35(1), pages 71-97, February.
    2. Ubel, Peter A. & Jepson, Christopher & Baron, Jonathan & Hershey, John C. & Asch, David A., 2003. "The influence of cost-effectiveness information on physicians' cancer screening recommendations," Social Science & Medicine, Elsevier, vol. 56(8), pages 1727-1736, April.
    3. Stevens, Warren & Normand, Charles, 2004. "Optimisation versus certainty: understanding the issue of heterogeneity in economic evaluation," Social Science & Medicine, Elsevier, vol. 58(2), pages 315-320, January.
    4. Johannesson, Magnus & Weinstein, Milton C., 1993. "On the decision rules of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 12(4), pages 459-467, December.
    5. Andre Ament & Rob Baltussen, 1997. "The Interpretation of results of economic evaluation: explicating the value of health," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 625-635.
    6. Douglas Coyle & Martin J. Buxton & Bernie J. O'Brien, 2003. "Stratified cost-effectiveness analysis: a framework for establishing efficient limited use criteria," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 421-427.
    7. Johannesson, Magnus, 1995. "The relationship between cost-effectiveness analysis and cost-benefit analysis," Social Science & Medicine, Elsevier, vol. 41(4), pages 483-489, August.
    8. Elamin H. Elbasha & Mark L. Messonnier, 2004. "Cost-effectiveness analysis and health care resource allocation: decision rules under variable returns to scale," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 21-35.
    9. Palmer, Stephen & Smith, Peter C., 2000. "Incorporating option values into the economic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 19(5), pages 755-766, September.
    10. Brouwer, Werner B. F. & Koopmanschap, Marc A., 2000. "On the economic foundations of CEA. Ladies and gentlemen, take your positions!," Journal of Health Economics, Elsevier, vol. 19(4), pages 439-459, July.
    11. Ben-Zion, Uri & Gafni, Amiram, 1983. "Evaluation of public investment in health care : Is the risk irrelevant?," Journal of Health Economics, Elsevier, vol. 2(2), pages 161-165, August.
    12. Nancy Devlin & David Parkin, 2004. "Does NICE have a cost-effectiveness threshold and what other factors influence its decisions? A binary choice analysis," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 437-452.
    13. Birch, Stephen & Gafni, Amiram, 1993. "Changing the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems," Journal of Health Economics, Elsevier, vol. 12(4), pages 469-476, December.
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    Cited by:

    1. Mathias Kifmann, 2010. "Indikationsspezifische Kosten-Nutzen-Bewertung auf Grundlage eines sozialen Gesundheitsindexes," Discussion Paper Series 310, Universitaet Augsburg, Institute for Economics.
    2. Timothy Gunning & Robin Sickles, 2011. "A multi-product cost function for physician private practices," Journal of Productivity Analysis, Springer, vol. 35(2), pages 119-128, April.

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