The state of cost–effectiveness analysis in American managed care

Abstract

In 1996, the US Panel on Cost–Effectiveness in Health and Medicine published detailed recommendations for the conduct and use of cost–effectiveness analyses (CEA) of medical technologies. These recommendations were expected to promote the use of CEA to inform the resource allocation decisions of a diverse audience including, among others, American managed care organizations. Yet, nearly 10 years later, the limited explicit use of CEA in the USA remains a prominent discussion topic, with few signs of resolution. Its limited use within managed care is especially striking given the industry’s stated interest in efficient healthcare and historically unstable finances in the face of continually rising healthcare costs.

Keywords::

• budget impact analysis
• business case
• cost analysis
• cost–benefit analysis
• cost–effectiveness analysis
• economic evaluation
• managed care
• return on investment