Summary of the article by Reinhardt
The author, in the article, presents an argument founded on whether to use comparative effectiveness analysis or cost-effectiveness analysis and the implications of using either. The argument is founded on the criticality of data collection to prove the effectiveness of medical interventions. The author focuses on the seemingly preference for comparative effectiveness analysis in policy circles. However, the author also presents an analysis of the relationship between the two concepts. The article also presents the reactions emanating from the inclusion of the approach to the analysis of effectiveness in the economic stimulus bill. From the article, it is possible to develop an understanding of what each of the two entails in the analysis of the effect of medical interventions and therapies. The author provides a discussion of the support and opposition to the approaches based on the effect each has on the different stakeholder groups. Mostly, the author focuses on the opposition for the cost-effectiveness analysis. The opponents indicate the importance of divorcing money from health care decisions, something that the author claims is not possible.
A Comparison of the Strengths and Weaknesses of the Approaches
The two approaches in analyzing the effectiveness of medical interventions differ in terms of the focus of the analysis. Comparative effectiveness analysis compares two therapies regarding effectiveness in terms of which of them is better based on negative and positive ramifications associated with each. On the other hand, cost-effectiveness analysis incorporates an economic element in the analysis of the effectiveness of medical interventions. The approach looks at a comparison of effect of interventions from an economic perspective (Woltmann, Grogan-Kaylor, Perron, Georges, Kilbourne & Bauer, 2012). The focus is on which is the most effective based on the negative and positive consequences as well as in terms of the cost of the interventions.
One of the strengths of the comparative effectiveness analysis is that it is highly structured. The approach can be used in making decisions about treatment by comparing the consequences of the alternatives and without the biases caused by the cost of interventions. The process is critical for guiding rigorous empirical research to establish the effectiveness of alternative treatments. The approach is founded on the premise that money should not be brought into the policy and decision making where health care is concerned (Woltmann et al., 2012). The approach also prevents the chances where quality care can be hindered by the use of monetary analysis in the decisions on health care. The method investigates the intervention based on its inherent nature to measure effectiveness.
By maintaining the analysis strictly to the clinical realm, comparative effectiveness analysis ignores the importance of the economic aspect of medical interventions. It is obvious that no intervention is developed without being attached to an economic implication. It makes no sense to invest millions in the development of treatments and ignore the cost of analyzing its feasibility (Woltmann et al., 2012). Denying the importance of money in health care interventions is a fallacy. Within the health care of the United States, which is plagued by high cost of care, one cannot deny that finances have an important role to play and cannot be ignored. Hence, comparative effectiveness analysis does not give the entire picture in relation to the effect of medical interventions by denying the important role of the economic elements.
The strength of cost-effectiveness analysis lies in the decision on whether the benefits of an intervention are worth the cost of generating or using it. It is not worth producing a therapy or procedure that will cost more than the benefits it will provide to the consumers. Hence, the approach is useful in assessing whether the costs can be justified by the effect of the procedure or intervention. The approach carries out a comparison between a number of medical interventions in deciding which among them can achieve results but at the least possible cost. The approach does not ignore the cost implications in a health care system that is struggling with a high cost of care. Cost-effectiveness analysis is more integrative and comprehensive as it investigates the clinical efficacy as well as the cost implications of an intervention in health care.
Cost-effectiveness analysis provides a high level of transparency. The approach offers a clear analysis of the cost involved in the production of a medical intervention against the benefits in terms of the effectiveness of the intervention. Hence, it provides more quantifiable data in analyzing the effectiveness of an intervention and comparing one intervention to the others. The results are so transparent that they can be used in making an important decision on what intervention to use. It makes a lot of economic sense and can prevent chances of investing in an unworthy intervention (Drummond, Sculpher, Claxton, Stoddart, & Torrance, 2015). The benefits of an intervention considering the cost can prevent one from making costly decisions in giving or receiving care. However, the cost-effectiveness analysis brings about the notion of the cost being more important than the need to provide care to the patient. The approach appears to place cost above any other objective of care. The opponents of this approach argue that cost should not be used as a hindrance to providing quality of care. Where cost is the most important aspect, quality can be greatly compromised. The concept of cost-effectiveness analysis is, in fact, offensive to some opponents of its use.
The Value of Cost-Benefit Analysis (CBA) and Cost-Effectiveness Analysis (CEA)
It is critical that decisions in clinical practice are guided by proof of effectiveness of the approaches used in providing treatment for different medical conditions. High-quality scientific testing should be carried out for all guidelines and interventions in treating the relevant conditions. Cost-benefit analysis makes a comparison between the cost and the benefits involved in the use of an intervention to make the decision as to whether to use it or not. If the benefit outweighs the cost, then the decision to use the intervention can be made. In case the cost is greater than the benefits, the procedure can be discarded altogether and other cost-effective interventions sought. In medical practice, there are always alternative treatments (Drummond et al., 2015). Hence, in case that the cost of two alternatives differs and the level of effectiveness is comparable, it makes more economic sense to use the one with less cost.
Clinical practices should use the analyses as the basis for making decisions on the alternative treatment to use. The information is crucial for different stakeholder within the health care system, including the insurance companies, individual consumers of healthcare, care providers, and pharmaceutical companies among others. The value of the projected cost of an intervention is critical in determining whether it is worthwhile (Drummond et al., 2015). For example, for an individual consumer or insurance company paying for the medical treatment, it is most beneficial to use the procedure that is highly effective and at the lowest cost possible.
Whether quantified in monetary terms, like in cost-benefit analysis, or in the general output, especially in cost-effectiveness analysis, the results of the analysis are critical in decision making in health care settings. The cost-benefit analysis looks into the cost against the benefit, both in monetary terms. On the other hand, cost-effectiveness analysis considers the cost in relation to outcomes such as diseases prevented, lives saved, or quality of life achieved (Nas, 2016). Hence, the data plays an important role in the decision about which alternative medical treatments have the potential to give the greatest benefits and the cost involved. It is especially important given the increasing number of alternative interventions for similar medical conditions. To decide on which one to use, the evidence of effectiveness is critical
Although there are some inherent beliefs that the health is priceless and that money should not be used as the basis for making important decisions related to care, no one can deny that money cannot be completely divorced from the care process. The cost and effectiveness of interventions cannot be ignored in care processes (Nas, 2016). In fact, no health care system can function without the finances. If applied well, cost-benefit analysis and cost-effective analysis can integrate many societal values. It can be used as the basis for proper decision making where the lives and wellbeing of the recipients of care are at stake.
With the growing cost of health care in the United States, it is critical for health policy planners to adopt the approaches to analyze the effectiveness of medical treatments. The analyses provide the much needed quantitative answers for the aptness of medical interventions and procedures. The results of the analysis not only aids decision making, but also provides the answers to the most challenging problems in health care as well as concealed ethical judgments (Rudmik & Drummond, 2013). Some of the decisions that can be supported by the results include alternative interventions for similar clinical objectives, most effective utilization of finances put aside for a particular course, empirical evidence for the assumption of a particular medical treatment or procedure, and revealing care approaches that are not worthwhile. The importance of the data provided from the analyses cannot be overemphasized in the modern health care settings where the cost of care is skyrocketing.
Medical researchers and analysts have a huge responsibility in providing the data and results to prove the effectiveness of medical interventions. The analysis involving human capital methodologies should be carefully implemented to provide results that are useful in practice. It is evident that there are situations where the definition of human value is by economic worth which leads to the need of determining that value in the processes that entail the care of the patients (Rudmik & Drummond, 2013). Although the quandary of the way of determining the human life’s value is not simple, it is an area that is worth greater efforts in providing the important answers to the unresolved questions. It is also critical for research to be carried out to resolve the criticism and opposition labeled in the use of cost-effectiveness analysis and cost-benefit analysis.
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