Abstract
Health service improvement interventions such as care pathways should be evaluated for cost-effectiveness the same way other health interventions are. I describe what cost-effectiveness analyses (CEAs) for care pathways are, how they are conducted and how their results are interpreted. CEAs should clearly state what perspective they are taking, what time frame is being considered and what research question is being addressed. Effectiveness measured by tangible patient outcomes (deaths averted, bed-days saved or QALYs [quality-adjusted life-years] gained) are preferable to process measures because they are easier for non-specialists to understand. Having a control group is highly desirable to enhance the case for attributability. Costs include explicit and opportunity costs of implementing the care pathway. Cost consequences include the change in expenditures attributable to changes associated with the care pathway. Dividing incremental cost by incremental effects gives an incremental cost-effectiveness ratio, the common measure of relative cost-effectiveness. Care pathways that decrease cost and improve outcomes should be implemented unequivocally. Those that improve outcomes but increase costs need to be considered according to the funder's willingness to pay for improved outcomes. CEAs for care pathways are as important as for any other health intervention and are necessary to provide information for decision makers.
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