Why don't Americans use cost-effectiveness analysis?

Cost-effectiveness analysis (CEA) offers decision makers a structured, rational approach with which to improve the return on resources expended. But decades after its widespread promotion to the medical community, policy makers in the United States remain reluctant to use the approach formally. Indeed, the resistance to economic evidence in the United States in an era of evidence-based medicine in healthcare is perhaps the most notable development of all. This paper examines the resistance to CEA in the United States and explores ways in which to advance the field.