Table 3.

Examples of the misuse of the incremental cost effectiveness ratio

Comparators	Incremental cost effectiveness ratio	Authors′ comments/interpretations
Combined antiretroviral therapy for HIV v no therapy	$13 000-23 000 per QALY gained	Treatment of HIV infection with a combination of three antiretroviral drugs is a cost effective use of resources10
3 days' hospitalisation following acute myocardial infarction v 4 days' hospitalisation	$105 629 per life year saved	Hospitalisation of patients with uncomplicated myocardial infarction beyond three days after thrombolysis is economically unattractive by conventional standards11
Low molecular weight heparins v unfractionated heparin	$7820 per QALY gained	Low molecular weight heparins are highly cost effective for inpatient management of venous thrombosis12
Screening for hereditary haemochromatosis v no screening	$508 per life year saved	HFE testing for the C282Y mutation is a cost effective method of screening relatives of patients13
Colonoscopy v occult blood testing	$11 382 per case detected	At a higher total cost of screening, colonoscopy represents a cost effective alternative because additional life years are saved to justify additional costs14
Specific mammography screening strategy in women over 70 v no screening	$66 773 per life year saved	. . . results in a small gain in life expectancy and is moderately cost effective15
Sildenafil v papaverine-phentolamine for erectile dysfunction	3639 per QALY gained	Treatment with sildenafil is cost effective16
Systematic diabetic eye screening v opportunistic screening	32 per true positive identified	Replacing existing programmes with systematic screening for diabetic eye disease is justified17
Two view v one view mammography reading	6589-6716 per case detected	Given limited resources, priority should be given to introducing double reading [as this] is more cost effective18

QALY=quality adjusted life year