Publication Details

Salkeld, G. (1999). Economic evaluation and EBM. Cancer Forum, 23 (3), 144-145.


In the world of textbook economics, the "sovereign" consumer weighs up the (freely available) evidence on the costs, risks, harms and benefits before purchasing health care. The value that consumers then attach to the evidence and the expected outcomes is revealed through their purchasing decisions in the market. Ultimately, the consumer's decision represents the best or benefit maximising choice given the available information. The notion of this evidence-based market is however a long way from the reality of health care in Australia. Consumers (that is, patients) generally do not have current best evidence to hand. The same could be said of their agent (doctor) prior to worldwide interest in evidence-based medicine (especially through the Cochrane Collaboration). If the market is not capable of integrating external clinical evidence from systematic research and clinical expertise such that consumers (or their agents for that matter) can assess the quality of information easily then a mechanism is needed to perform that function. One such mechanism is economic evaluation. This approach describes a set of techniques, such as cost-effectiveness analysis and cost-benefit analysis, that require the systematic comparison of the costs and benefits of the full range of health care activities. Economic evaluation performs what individual consumers would otherwise do in a competitive market; it weighs up the costs and benefits of the available choices. That still leaves many questions about whose values count in the aggregation of costs and benefits and whether the value of the total is greater than the sum of individual values. Nonetheless, if one of the aims of a health care system is to be efficient, then choosing those programs that provide the greatest benefits for the resources available will delivery an efficient allocation of health care resources. Allocating health care resources is seldom simply a matter of choosing efficient programs; the 'fairness' or equity of resource allocation is also a desirable economic goal. The aim of this paper is to provide a brief account of what economic evaluation has achieved and could achieve in cancer control within an EBM environment. The first part looks at funding lor health services based on evidence of economic evaluation. The following section of the paper highlights some innovative research into the use of EBM to elicit consumer preferences for colorectal cancer screening.