Cost-effectiveness analysis: from science to application.

This article proposes ways to improve the credibility and use of cost-effectiveness analysis (CEA) in healthcare decision-making. We argue that the major issue is not the credibility of CEA as a methodology; although there are methodologic challenges, they can be addressed. Two issues, however, will require effort on the part of stakeholders to achieve consensus. First, agreement must be reached regarding the standards of evidence required to support healthcare policy decisions. Second, and of greater importance, the process of healthcare resource allocation decision-making must be viewed as credible and legitimate. We believe that the legitimacy of policy decisions regarding healthcare resource allocation and the acceptance of CEA as a decision tool informing the decision process will require both broad-based stakeholder engagement and transparency throughout the process. For this to occur, stakeholder groups must come to consensus on how to address competing policy goals. Specifically, how should we balance the desires for equity, universal access to healthcare services and technology, and the right of individuals to secure the specific healthcare resources they want?