We consider the problem of assessing new and existing technologies for their cost-effectiveness in the case where data on both costs and effects are available from a clinical trial, and we address it by means of the cost-effectiveness acceptability curve. The main difficulty in these analyses is that cost data usually exhibit highly skew and heavy-tailed distributions, so that it can be extreme...

Recently, there has been much interest in using the cost-effectiveness acceptability curve (CEAC) to measure the statistical evidence of cost-effectiveness. The CEAC has two well established but fundamentally different interpretations: one frequentist and one Bayesian. As an alternative, we suggest characterizing the statistical evidence about cost-effectiveness using the likelihood function (t...

BACKGROUND The National Department of Health of South Africa decided to start a programme to train mid-level healthcare workers, called clinical associates, as one of the measures to increase healthcare workers at district level in rural areas. Unfortunately, very little is known about the cost effectiveness of clinical associates. AIMS To determine, on a provincial level, the cost effectiven...

We appreciate the efforts of the California Air Resources Board (CARB) to develop economic frameworks and tools for the package of policies necessary to implement California Global Warming Solutions Act of 2006 (AB 32) and meet the requirements of the law. These comments are submitted in anticipation of the June 3, 2008 Economic Analysis Technical Stakeholder Working Group meeting, which will f...

Because of the workings of health care systems, new, important, and cost-effective treatments sometimes do not become routine care while well-marketed products of equivocal value achieve widespread adoption. Should policymakers attempt to influence clinical behavior and correct for these inefficiencies? Implementation methods achieve a certain level of behavioral change but cost money to enact....

In low and middle income countries, health workers are essential for the delivery of health interventions. However, inadequate health-worker performance is a very widespread problem. We present an overview of issues and evidence about the determinants of performance and strategies for improving it. Health-worker practices are complex behaviours that have many potential influences. Reviews of in...

This chapter gives an overview of benefit-cost analysis (BCA) and similar evaluation tools, such as cost-effectiveness analysis and technology-based standards, in the context of public health. We describe these evaluation tools, how they are used, their shortcomings, and how they should be interpreted. As with other powerful tools, they are subject to misuse and misinterpretation, even by profe...