This article summarizes the results of a critical review of several cost benefit analyses (CBA) of health care programs. With pertinent examples, it is demonstrated that the results and conclusions of a study depend upon the assumptions and methods underlying the measurement of costs and benefits in a CBA. Given the incentives for an analyst to comply with desires of his sponsor, and given the scope of the choice available to an analyst among alternative assumptions and methods, it seems quite possible that desired results often dictate the assumptions and methods chosen. It is recommended that apolicy maker should suspect an advocacy in the results and conclusions of every CBA. If CBAs are to be a true decision aid, a policy maker ought to obtain several of them, each of which assesses the costs and benefits of a given action plan using assumptions and methods substantially different from the other.
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References
1.
BARLOW, R.
(1968) The Economic Effects of Malaria Eradication. Research Series 5. Bureau of Public Health Economics. Ann Arbor: University of Michigan.
2.
BAUMOL, W. J.
(1968) "On the social rate of discount."Amer. Economic Rev.58, 4. (September): 788-802.
3.
BICKLEY, J. H., D. C. CAVANDER, and J. C. MADDOX (1978) Estimating Potential and Realizable Cost Savings from Medical Formularly Additions: A Pilot Study of Keflex Use in Eight Diagnosis Codes. Eli Lilly & Company (July). (unpublished)
4.
BODEN, L. I.
(1979) "Cost-benefit analysis: caveat emptor."Amer. J. of Public Health69, 12: 1210-1211.
5.
BRAND, M.
, A. MENZL, M. ESCHER, and B. HORISBERGER (1975) From Electroshock Therapy to Antidepressants: A Cost-Benefit Study. Pharma Information. Basle, Switzerland.
6.
BRUNGGER, H.
(1972) "Health in cost-benefit analyses: the case of the new drug 1-dopa."Schwiz Zeitechur Fur Volkswirtshaft and Statisik: 347-375.
7.
BUNKER, J. P.
, B. BARNES, and F. MOSTELLER (1977) Costs, Risks, and Benefits of Surgery. New York: Oxford Univ. Press.
8.
CARD, W. J.
and G. H. MOONEY (1977) "What is the monetary value of human life."British Medical J. (December): 1627-1629.
9.
CHURCHMAN, C.
(1971) "On the facility, felicity and morality of measuring social change."Accounting Rev. (January): 30-35.
10.
CONLEY, R. W.
(1975) "Issues in benefit-cost analysis of the vocational rehabilitation program."Amer. Rehabilitation (November/ December): 19-24.
11.
COOPER, B. S.
and D. P. RICE (1976) "The economic cost of illness revisited."Social Security Bull.31, 2 (February).
12.
CUSANO, P. P.
, J. MAYO, and R. A. O'CONNEL (1977) "The medical economics of lithium treatment for manic depressives."Hospital and Community Psychiatry28, 3 (March): 169-173.
13.
DRUMMOND, M. F.
(1978) "Evaluation and the National Health Service." In A. J. Culyer and K. G. Wright (ed.) Economic Aspects of Health Services. London: Martin Robertson.
14.
DWORKIN, F.
(1980) "On estimating the economic impact of regulations: a case study on trade secrets disclosure."Managerial and Decision Economics1, 4 (December): 197-200.
15.
FEIN, R.
(1977) "But, on the other hand: high blood pressure, economics and equity."New England J. of Medicine296, 13 (March): 751-753.
16.
FINEBERG, V. H. and L. A. PEARLMAN (1979) "Benefit and cost analysis of medical interventions: the case of cimentidine and peptic ulcer disease." Harvard School of Public Health. (unpublished)
17.
FRIED, C.
(1975) "Rights and health care-beyond equity and efficiency."New England J. of Medicine293, 5 (July): 241-245.
18.
GEISER, E. G.
and F. C. MENZ (1976) "The effectiveness of public dental care programs."Medical CareXIV, e: 189-198.
19.
GROSS, A. M.
(1976) Is Cost-Benefit Analysis Beneficial? Is Cost-Effectiveness Analysis Effective?F. Heller School for Advanced Studies in Social Welfare. Waltham, MA: Brandis University National Technical Information Service and U. S. Department of Commerce.
20.
HANNAN, T. H.
(1976) "The benefits and costs of methadone maintenance."Public Policy24, 2 (Spring).
21.
HATRY, H. P.
(1970) "Measuring the effectiveness of nondefense public programs."Operational Research Q. (October): 772-784.
22.
HAUNALTER, G. V.
and V. V. CHANDLER (1977) Cost of Ulcer Disease in the United States. Menlo Park, CA: Stanford Research Institute.
23.
HEFNER, D. L.
(1979) A Study to Determine the Cost-effectiveness of a Restrictive Formulary: The Louisianna Experience. Washington, D.C.: National Pharmaceutical Council.
24.
HOOS, I. R.
(1972) "Systems Analysis in Public Policy: A Critique."Los Angeles: Univ. of California Press.
25.
JOGLEKAR, P. N.
(1982) "Advocacy through convenient definition of societal objectives: the case of cost-benefit analysis in health care."Evaluation & the Health Professions5: 363-379.
26.
JOGLEKAR, P. N.
(1979) "Cost-Benefits of Health Care Programs: A Review of Methodologies Used." Presented at Operations Research Society of America, National Conference.
27.
JONSSON, B.
(1976) Cost-Benefit Analysis in Public Health and Medical Care. Lund, Sweden: Printlab.
28.
LEVINE, H. M.
(1975) "Cost-effectiveness analysis in evaluation research," pp. 89-112 in M. Gettentag and E. L. Struening (ed.) Handbook of Evaluation Research. Volume II. Beverly Hills, CA: Sage Publications.
29.
MCBRIDE, A. D.
, J. L. BOOZER, and G. J. MERTZ (1976) "Rubella vaccination policies."New England J. of Medicine294, 20: 1126-1126.
30.
MISHAN, E. J.
(1971) "Evaluation of life and limb: a theoretical approach."J. of Political Economy79, 4-4.
31.
MUSHKIN, S. J.
(1962) "Health as an investment."J. of Political Economy70.
32.
Netherlands Economic Institute
(1977) Present Cost of Peptic Ulceration to Dutch Economy and Possible Impact of Cimetidine on This Cost. Rotterdam.
33.
PELTZMAN, S.
(1974) Regulation of Pharmaceutical Innovation: The 1962 Amendments. American Enterprise Institute for Public Policy Research. Washington, DC.
34.
QUADE, E. S.
(1975) Analysis for Public Decisions. New York: Elsevier North-Holland.
35.
RIDDIOUGH, M.
(1979) "Cost-Effectiveness Analysis of Vaccination." Office of Technology Assessment Report 4.
36.
Robinson Associates Inc.
(1978) The Impact of Cimetidine on the National Cost of Duodenal Ulcers. Bryn Mawr, PA.
37.
ROTHENBERG, J.
(1975) "Cost-benefit analysis: a methodological exposition." In M. Gettentag and E. L. Struening (ed.) Handbook of Evaluation Research. Beverly Hills, CA: Sage Publications.
38.
RUFENER, B. L.
, V. J. RACHAL, and A. M. CRUZE (1977) Management Effectiveness Measure for NIDA Drug Abuse Treatment Programs. Volumes I and II. National Institute on Drug Abuse. Washington, DC: Government Printing Office.
39.
SASSONE, P. G.
and W. A. SCHAFFER (1978) Cost-Benefit Analysis-A Handbook. New York: Academic Press.
40.
SCHOENBAUM, S. C.
, J. N. HYDE, Jr., L. BARTODHESKY, and K. CRAMPTON (1976) "Benefit-cost analysis of rubella vaccination policy."New England J. of Medicine294, 6 (February): 306-310.
41.
SCHRAMM, C. J.
(1977) "Measuring the return on program costs: evaluation of a multi-employer alcoholism treatment program."Amer. J. of Public Health67, 1. (January): 50-51.
42.
SELF, P.
(1975) Econocrats and the Policy Process: The Politics and Philosophy of Cost-Benefit Analysis. London: Macmillan.
43.
STASON, W. B.
and M. C. WEINSTEIN (1977) "Allocation of resources to manage hypertension."New England J. of Medicine296, 13: 732-739.
44.
STEINER, K. C.
and H. A. SMITH (1976) "Application of cost-benefit analysis to a PKU screening program."InquiryX, 4: 34-40.
45.
STILWELL, J. A.
(1976) "Benefits and costs to school's BCG vaccination programs."British Medical J.: 1002-1004.
46.
WEINSTEIN, M. C.
and W. B. STASON (1977) "Foundations of cost-effectiveness analysis for health and medical practices."New England J. of Medicine296, 13: 716-721.
47.
WEISBROD, B. A.
(1971) "Costs and benefits of medical research: a case study of poliomyelitis."J. of Political Economy79, 3. (May-June): 527-544.
48.
WEISBROD, B. A., M. A. TEST, and L. T. STEIN (1978) An alternative to mental hospital treatment: III. economic benefit-cost analysis. (unpublished)
