Understanding Harris’ understanding of CEA: is cost effective resource allocation undone?

Harris has been a vocal critic of CEA and the QALY for over 20 years. In this paper we attempt to summarise and evaluate both Harris’ criticisms of CEA and the alternative procedures he commends to health care decision makers. Harris’ basic position is that all health benefits are indivisible and, unless a strong argument can be made, of equal worth. He argues individuals have a right to treatment that cannot be denied by a decision maker on the basis of their ability to benefit and therefore that life saving treatments dominate life enhancing treatments in all circumstances, regardless of the QALY benefits in both cases. In this paper we review Harris’ arguments against the use of CEA and QALYs and critically appraise his suggestions for alternative approaches to health care resource allocation. We conclude that whilst his work has challenged the proponents of CEA and QALYs to be explicit about the method’s discriminatory characteristics, his arguments are largely based upon the flawed assumptions that lives can be saved, rather than death postponed; and that opportunity cost can be sidestepped by attempting to impose the same outcome for all.