Comparing both the cost and effectiveness of 2 medical management strategies can be help in deciding which to use in a given patient.
Issues:
(1) basis for cost comparison
(2) measures of clinical outcome: survival, quality of life, fewer side effects, etc.
(3) decision on breakpoints
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Cost Comparison
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Clinical Outcome for 2 Different Management Strategies
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A > B
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A = B
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A < B
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A > B
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calculate marginal cost effectiveness ratio
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select B (cheaper)
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select B (cheaper and better outcome)
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A = B
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select A (better outcome)
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both comparable, select either
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select B (better outcome)
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A < B
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select A (cheaper and better outcome)
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select A (cheaper)
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calculate marginal cost effectiveness ratio
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The marginal cost effectiveness ratio should be calculated when the more expensive strategy is also the more effective.
