Cost-benefit analysis

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Cost-benefit analysis is used to evaluate projects that generate non-financial costs and benefits by taking account of the preferences of those affected. It has applications to the provision of public goods for which preferences are not reflected in market prices. Although its quantitative results are necessarily approximate, they can often provide a decisive guide to a choice among alternatives. It is claimed that, by taking account of the strengths of preferences, cost-benefit analysis can provide a better guide to choice than can be obtained from voting.

Methodology

The basic method

The decision criterion of a cost-benefit analysis uses the summation of the effects of the expected outcomes of a project on people within its scope. To make a summation possible, a monetary cost or benefit is assigned to each of those effects. (The term "cost-effectiveness" is a applied to an analysis in which only the costs are monetised.) The summation used is then the of the costs and benefits of each effect, weighted by their estimated probability of occurrence, and discounted using the estimated time preference rates of those affected. The acceptance criterion for a single project is a positive value of the resulting net present expected value of the excess of benefits over costs, and the acceptance criterion for the acceptance of one among several alternatives is that it should be the one with the highest net present expected value.

Scope

The scope of an analysis is normally determined by the requirements of its prospective users. The evaluation of a medical procedure might, for example, be concerned solely with its effects on patients and their families, or it might also encompass effects on the hospital or the public at large. An evaluation of migration commissioned by a European government might or might not include effects upon migrants and their families, but an evaluation commissioned by the European Union might be expected to be concerned with the effects upon all of its inhabitants.

Measurement methods

Aggregation

Probability weighting and discounting

Treatment of risks

Applications

Health

Transport

The enviroment

Climate change

Limitations, qualifications and advantages

Metrics used in cost-benefit analyses

  • Cost per year of life saved[1] The definition of an acceptable cost per year of life saves ranges from $50,000 to $200,000.[2]
  • Cost of Preventing an Event (COPE)[3]. For example, to prevent a major vascular event n a high-risk adult , the number needed to treat is 19, the number of years of treatment are 5, and the daily cost of the generic drug is 68 cents. The COPE is 19 * 5 * ( 365 * .68) which equals $23,579 in the United States.
  • Years (or months or days) of life saved. "A gain in life expectancy of a month from a preventive intervention targeted at populations at average risk and a gain of a year from a preventive intervention targeted at populations at elevated risk can both be considered large."[4]

Standards in conducting a cost-benefit analysis

Standards have been developed for the conduct of cost-benefit analyses[5][5] and for systematic reviews of cost-benefit analyses[6].

The two most common problems in publications of cost-benefit analyses are not stating the study perspective (e.g. is the cost born by the patient, health case system, or society) and not disclosing the funding source.[7]

Difficulties in cost-benefit analyses

The costs saved by successful treatment of one disease may be offset by greater longevity leading to increased costs from other disease.[8]

Recommendations have bee published on how to read and interpret a cost-benefit analysis.[9][10][11][12]

[13]

[14]

References

  1. ↑ Tengs TO et al (1995). "Five-hundred life-saving interventions and their cost-effectiveness". Risk Anal 15: 369–90. PMID 7604170. [e]
  2. ↑ Cutler DM, Rosen AB, Vijan S (2006). "The value of medical spending in the United States, 1960-2000". N. Engl. J. Med. 355 (9): 920-7. DOI:10.1056/NEJMsa054744. PMID 16943404. Research Blogging.
  3. ↑ Maharaj R (2008). "Adding cost to NNT: the COPE statistic". ACP J. Club 148 (1): A8. PMID 18170986. [e]
  4. ↑ Wright JC, Weinstein MC (1998). "Gains in life expectancy from medical interventions--standardizing data on outcomes". N Engl J Med 339: 380–6. PMID 9691106. [e]
  5. ↑ 5.0 5.1 Siegel JE, Weinstein MC, Russell LB, Gold MR (1996). "Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine". JAMA 276 (16): 1339–41. PMID 8861994. [e] Cite error: Invalid <ref> tag; name "pmid8861994" defined multiple times with different content
  6. ↑ Jefferson T, Demicheli V, Vale L (2002). "Quality of systematic reviews of economic evaluations in health care". JAMA 287 (21): 2809-12. PMID 12038919. [e]
  7. ↑ Neumann PJ, Stone PW, Chapman RH, Sandberg EA, Bell CM (2000). "The quality of reporting in published cost-utility analyses, 1976-1997". Ann. Intern. Med. 132 (12): 964-72. PMID 10858180. [e]
  8. ↑ van Baal PH, Polder JJ, de Wit GA, et al (2008). "Lifetime Medical Costs of Obesity: Prevention No Cure for Increasing Health Expenditure". PLoS Med. 5 (2): e29. DOI:10.1371/journal.pmed.0050029. PMID 18254654. Research Blogging.
  9. ↑ Drummond MF, Richardson WS, O'Brien BJ, Levine M, Heyland D (1997). "Users' guides to the medical literature. XIII. How to use an article on economic analysis of clinical practice. A. Are the results of the study valid? Evidence-Based Medicine Working Group". JAMA 277 (19): 1552-7. PMID 9153371. [e]
  10. ↑ O'Brien BJ, Heyland D, Richardson WS, Levine M, Drummond MF (1997). "Users' guides to the medical literature. XIII. How to use an article on economic analysis of clinical practice. B. What are the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group". JAMA 277 (22): 1802-6. PMID 9178794. [e]
  11. ↑ Greenhalgh T (1997). "How to read a paper. Papers that tell you what things cost (economic analyses)". BMJ 315 (7108): 596-9. PMID 9302961. [e]
  12. ↑ Detsky AS, Naglie IG (1990). "A clinician's guide to cost-effectiveness analysis". Ann. Intern. Med. 113 (2): 147-54. PMID 2113784. [e]
  13. ↑ Appraisal and Evaluation in Central Government, HM Treasury, 2003
  14. ↑ Managing risks to the public: appraisal guidance, HM Treasury, 2005
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