A
cost-effectiveness model based on a previously published and validated analytic decision-tree (13) was used to compare the direct costs and outcomes of the three drugs.
The
cost-effectiveness of antiretroviral therapy in the Caribbean was studied using the
Cost-Effectiveness of Preventing AIDS Complications (CEPAC) international model, an adaptation of the CEP AC US model, a state-transition simulation model of HIV disease in resource-limited settings.
It is tempting--and perhaps legitimate--to ask whether all the health interventions used in PAHO's technical cooperation programs would pass the test of
cost-effectiveness. The results of such a test would, of course, be relative; some would emerge as more cost-effective than others.
Previous studies have examined the
cost-effectiveness of influenza vaccination in various age groups (8-10).
The question to ask in
cost-effectiveness analysis is: Which alternative returns the most value in relation to the overall cost?
Norheim draws attention to criticisms of earlier versions of DCP, notably the use of
cost-effectiveness as a key criterion for decision-making to the exclusion of affordability, ethics, equity, legitimacy and human rights.
Equally importantly, evaluations of its
cost-effectiveness, including economic evaluations of NM both as a replacement for and a complement to standard care must be undertaken.
He disclosed serving as the principal investigator of a National Cancer Institute study on
cost-effectiveness analyses to determine reasonable options for cervical cancer screening.
Their finding was that a risk-stratified screening strategy could improve the benefit-to-harm ratio and the
cost-effectiveness of the breast screening programme, with diminishing return with screening offered to women at lower risk.
As such, exclusion lists would purportedly reflect the value-based factors of clinical and
cost-effectiveness. Pharmacy benefit managers establish clinical equivalency of drags in a therapeutic classification system in terms of safety and effectiveness.
(1) In this commentary, we use this example to highlight potential pitfalls of prioritizing
cost-effectiveness in the application of HTA to the exclusion of other considerations, especially when estimates of
cost-effectiveness are driven more by modelling than data.