Including patient choice in cost-effectiveness decision rules

S Dixon


There has been increasing discussion in the economic literature, about the
appropriateness of using general population values within technology appraisal.
This paper proposes an alternative approach to incorporating patient values into
the cost-effectiveness decision rule that lies at the heart of funding decisions.
Whilst the current decision rule is constructed around a technical question,
namely, ‘which treatment is the most cost-effective?’, the key policy question is
‘which treatments should be offered to the patient?’. A two-part decision rule is
explored which gives the patient the choice of the most cost-effective treatment
plus all cheaper options. Whilst the adoption of this patient-based costeffectiveness
rule may not alter many decisions compared to the current
approach, it would represent a profound shift in the way that patient values and
patient choice are incorporated into economic evaluation.