Cost - Effectiveness Analysis, Extended Dominance, and Ethics

Medical Decision Making - Tập 14 Số 3 - Trang 259-265 - 1994
Scott B. Cantor1
1Department of Family Medicine, University of Texas, Galveston 77555-0853.

Tóm tắt

The principle of extended dominance is applied in incremental cost-effectiveness analysis to eliminate from consideration strategies whose costs and benefits are improved by a mixed strategy of two other alternatives. Ethical considerations arise, however, in that equal care is not provided to all of the population. To explore these concerns, the authors establish a theoretical health care example with three diagnostic strategies. They demonstrate, both algebraically and geometrically, how to calculate the set of all possible mixed strategies that dominate the strategy eliminated by extended dominance. With the consideration of budget constraints, they define the "coefficient of inequity" as the minimum proportion of the pop ulation that would receive an inferior health care strategy if a mixed strategy were to be used instead of the dominated strategy. The implications of cost-effectiveness analysis are made explicit, revealing classic economic concerns about the tradeoff of equity and efficiency. Key words: cost-effectiveness analysis; extended dominance; economics; ethics. (Med Decis Making 1994;14:259-265)

Từ khóa


Tài liệu tham khảo

Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical Decision Analysis. Philadelphia : W. B. Saunders, 1980, p 260.

10.1177/0272989X8100100403

Keeney RL, 1976, Decisions with Multiple Objectives: Preferences and Value Tradeoffs

Raiffa H., Schwartz WB, Weinstein MC Evaluating health effects of societal decisions and programs. Decision Making in the Environmental Protection Agency (Vol. IIb, National Academy of Sciences, 1977), 1-81.

10.1111/j.1539-6924.1985.tb00153.x

Kamlet MS, 1992, The Comparative Benefits Modeling Project: A Framework for Cost-utility Analysis of Government Health Care Programs

10.1177/0272989X9201200102

10.1007/978-94-011-2392-1_5

Hollenberg J., 1989, SMLTREE 2.9

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Thông tin xuất bản

Medical Decision Making

Tập 14 Số 3

259-265

Thông tin tác giả