A seasonal cost effectiveness analysis: the last Noel?

Health economists are ideologically opposed to frivolity. It has come to our attention that an annual, quasireligious festival has been held for some years without having been subjected to the rigours of a cost effectiveness analysis. In these sombre days of economic rationalism, such an oversight is unconscionable. The money spent on gifts and wrapping paper, tinsel and turkey is a significant opportunity cost, which might be better spent on improving the health care of the nation. We present a cost effectiveness analysis of Christmas.

Methods

Our cost effectiveness analysis was carried out from a societal perspective, using clinical and economic variable estimates, derived by inspired guesswork. We assumed that the average doctor has no knowledge or interest in accountancy and will accept anything a health economist tells him or her without question; when it comes to knowledge of health economics, medical practitioners are considered bankrupt. We then assumed anything we thought would support our original hypothesis.

But how to compare the relative importance of different healthcare outcomes? Can we compare apples and oranges with tangerines? In a word, yes. The health economist has developed innovative, albeit inexplicable, measurement tools to allow us to do this. The best known are the DALY or disability adjusted life year and the QALY or quality adjusted life year. As these can scarcely do justice to the magic of Christmas, we have extrapolated this logic to include the JOLLY or joyous outcome living longer at Yuletide and the HOLLY or happiness outweighs less lean years. We accept, however, that the final arbiter of funding, which over-rules all decisions, regardless of science, economics, or common sense, is the POLY or politically orientated life year, which is a measure of projected government longevity. The POLY is based on a complex matrix of polling, personality, and pragmatism and determines how many seats will be saved at the next election.

We included direct costs, indirect costs, and intuitive costs. Direct costs were the sum of the money spent each year on Christmas trees, Christmas tree lights, mistletoe, decorations, baubles and crackers, and Father Christmas costumes (the Santa clause). Indirect costs included treatment costs of tinsellitis, food poisoning, and intravenous treatment for allergy to plants, called the Holly and the IV. Intuitive costs were any hidden costs we felt like adding, based on our gut feeling—costs that cannot be challenged because they are hidden. The only benefit of Christmas we were able to include was reindeer manure.

Sensitivity is not a term that carries any meaning to a health economist, since emotions are excluded from any cost effectiveness analysis. The psychological effects of good health outcomes, such as joy and happiness, or of poor health outcomes, such as misery, stress, and sadness, are not considered valid in any analysis of the costs and benefits of health intervention. In future we propose only to perform an insensitivity analysis.

We discounted any religious argument that did not support our personal view of the value of Christmas. We modelled a bit and muddled a bit, explored the Scrooge factor, and used the St Nicholas simulation to obtain a measure of net costs and savings, with a 95% confidence of total obfuscation. We used a Yule log transformation of the data.

Results

Christmas is not cost effective.

Discussion

There is no discussion. We will, however, recommend to the government that considerable cost savings could be made by the immediate abolition of Christmas. Next Christmas could be the last Noel.

We will next be applying for a grant to examine the cost effectiveness of Easter.