Just when you thought it was safe to dismiss cost effectiveness analysis as another dry and boring topic, of interest only to geeky economists or hard hearted bureaucrats, a book has emerged that makes the subject unexpectedly compelling.
Figure 1.
Peter J Neumann
Oxford University Press, £21.50, pp 224 ISBN 0 19 517186 1
Rating: ★★★★
The Harvard academic Peter Neumann passionately and eloquently articulates why we should all take more of an interest in how our health system gets value for money from medical treatments and technologies. More importantly it shows why the country with the world's biggest and most dysfunctional health economy, the United States, has been so slow to embrace this tool for rationally making decisions about money and medicine.
“As health spending in the United States soars past $1.5 trillion,” Neumann explains with characteristic drama and simplicity, “cost effectiveness analysis lies at the heart of perhaps the ultimate health policy question: how can we get good value for our money?”
Put crudely, cost effectiveness analysis is a way of working out the cost per effect from a drug, prevention strategy, device, or procedure. It's a set of equations for calculating how much money it will require to produce an extra year of human life, using statins, or breast cancer screening, or the Mediterranean diet.
Despite its eye glazingly tedious title, the book will have widespread appeal. It is accessible, clear, and unpretentious. It has humility and warmth rather than the hubris and chill you might expect from an academic text originating in Harvard University.
Chapter by chapter the reader learns what cost effectiveness analysis is, why it is important to policy makers, health professionals, and the public, and who does it well and who doesn't. Although the book has a lot of good, dispassionate scholarship, it also contains analysis and editorial comment, spread throughout. For the US based Neumann, cost effectiveness analysis is a way “to bring a structure and order and scientific reasoning to an unruly and inequitable health care system.”
In some ways the book seems to have been written with a sense of exasperation that the United States has been so slow to take up this tool, whereas many countries in Europe are well advanced in how they make decisions about what gives value for money and what doesn't. Yes, cost effectiveness analysis is an uncertain science; but while it is maturing in many places around the world—notably Australia—it hasn't even begun to crawl in most parts of the United States.
Why is this so? The fear in the United States is of course the R word: not reds, but rationing.
Items reviewed are rated on a 4 star scale (4=excellent)