Departures from cost-effectiveness recommendations: The impact of health system constraints on priority setting

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Title: Departures from cost-effectiveness recommendations: The impact of health system constraints on priority setting
Author(s): Hauck, KD
Thomas, R
Smith, PC
Item Type: Journal Article
Abstract: The methods and application of cost-effectiveness analysis have reached an advanced stage of development. Many decision makers consider cost-effectiveness analysis to be a valid and feasible approach towards setting health priorities, and it has been extensively applied in evaluating interventions and developing evidence based clinical guidelines. However, the recommendations arising from cost-effectiveness analysis are often not implemented as intended. A fundamental reason for the failure to implement is that CEA assumes a single constraint, in the form of the budget constraint, whilst in reality decision-makers may be faced with numerous other constraints. The objective of this paper is to develop a typology of constraints that may act as barriers to implementation of cost-effectiveness recommendations. Six categories of constraints are considered: the design of the health system; costs of implementing change; system interactions between interventions; uncertainty in estimates of costs and benefits; weak governance; and political constraints. Where possible -and if applicable- for each class of constraint, the paper discusses ways in which these constraints can be taken into account by a decision maker wishing to pursue the principles of cost-effectiveness.
Publication Date: 20-Jan-2016
Date of Acceptance: 20-Nov-2015
URI: http://hdl.handle.net/10044/1/29382
DOI: https://dx.doi.org/10.1080/23288604.2015.1124170
ISSN: 2328-8604
Publisher: Taylor & Francis
Start Page: 61
End Page: 70
Journal / Book Title: Health Systems & Reform
Volume: 2
Issue: 1
Copyright Statement: © 2015 The Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non-Commercial License (http://creativecommons. org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.
Publication Status: Published
Appears in Collections:Primary Care and Public Health
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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