Evaluation of surgical therapy by cost-benefit analysis.

Cost-benefit analysis (CBA) is described briefly, emphasizing the contribution this technique can make in justifying health care programs vying with other costly public programs for support. Costs and benefits of two surgical diagnostic techniques are outlined briefly as illustrations of the analysis. The first analyzes routine intraoperative cholangiography indicating the slight benefits that accrue from its use in terms of mortality and hospital expense. A more complicated example is an analysis of a policy of universal annual uterine cervical smears in asymptomatic women for cancer prevention where, granted the assumptions of the model, the costs minus the benefits of the program are estimated to be $565,000/beneficiary/year. The average beneficiary will gain 22 years of life at an average cost/year of about $26,000. The two examples are presented primarily as illustrations of a methodology which is being applied widely in medicine and public policy planning. Second, the marshalling of facts in CBA of a policy of annual uterine smears is of interest to those concerned with the justification of this screening procedure.