Priority setting in health: origins, description and application of the Australian Assessing Cost–Effectiveness initiative

Abstract

This article reports on the ‘Assessing Cost–Effectiveness’ (ACE) initiative in priority setting from Australia. It commences with why priority setting is topical and notes that a wide variety of approaches are available. In assessing these various approaches, it is argued that a useful first step is to consider what constitutes an ‘ideal’ approach to priority setting. A checklist to guide priority setting is presented based on guidance from economic theory, ethics and social justice, lessons from empirical experience and the needs of decision-makers. The checklist is seen as an important contribution because it is the first time that criteria from such a broad range of considerations have been brought together to develop a framework for priority setting that endeavors to be both realistic and theoretically sound. The checklist will then be applied to a selection of existing approaches in order to illustrate their deficiencies and to provide the platform for explaining the unique features of the ACE approach. A case study (ACE-Cancer) will then be presented and assessed against the checklist, including reaction from stakeholders in the cancer field. The article concludes with an overview of the full body of ACE research completed to date, together with some reflections on the ACE experience.

Keywords::

• ACE approach
• cost–effectiveness
• equity and social justice
• needs of decision-makers
• priority setting checklist
• resource allocation

Acknowledgements

Each of the ACE studies involved a Working Group of stakeholders and some also involved Steering Committees or Technical Advisory Panels. We are very appreciative of the input and contribution to the studies provided by these stakeholders and collaborators. Finally, but certainly not least, the ACE studies have relied upon dedicated research staff who have been an important part of the research program. We thank them for their vital contribution to the research endeavors.

Financial & competing interests disclosure>

The ACE research program has been funded and/or supported by a range of organizations and individuals. In particular the authors acknowledge, with thanks, funding support from the Commonwealth Department of Health and Aged Care for the ACE-Cancer study, the Australian National Health and Medical Research Council for the ACE-Heart Disease and ACE-Prevention studies, the Commonwealth Department of Health and Aged Care and the Victorian Department of Human Services for the ACE-Mental Health study, the Victorian Department of Human Services for the ACE-Obesity study, the Victorian Quit program and the South Australian Health Commission for the Community Health studies. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

For each criterion the letters in parenthesis indicate the relevant rationale: economic theory (T), ethical rationale (E), pragmatic rationale (P) and user considerations (U).

CEA: Cost–effectiveness analysis; CUA: Cost–utility analysis; MEEM: Macro Economic Evaluation Model; PBAC: Pharmaceutical Benefits Advisory Committee; PBMA: Program Budgeting and Marginal Analysis; QALY: Quality-adjusted life year.

CBA: Cost–benefit analysis; CEA: Cost–effectiveness analysis; CUA: Cost–utility analysis; MEEM: Macro Economic Evaluation Model; PBMA: Program Budgeting and Marginal Analysis.