Making difficult choices: decision making in health care

The aim of the research project was to explore the extent to which the current deployment of resources within the Oxfordshire region (formerly Oxfordshire Health Authority boundaries at project commencement), and recent decisions about deployments, are consistent with the principles of cost-effectiveness analysis.

The first part of this research project has involved setting up a database of all cost-effectiveness studies (those reporting cost per life year and cost per QALY) published between 1997 and 2003.

The database includes detailed information about each study. Such details include:

• the disease area;
• type of intervention;
• the study design;
• the country in which the study is based.

From this database it is possible to ascertain which interventions are very cost-effective and those that are not cost-effective.

Using Oxfordshire data on prescribing and clinical activity rates and information from clinical experts it was possible to compare whether the current deployment of resources was consistent with the published cost-effectiveness results for particular interventions.

The results showed that the current deployment of health care resources was not consistent with the principles of cost-effectiveness analysis. Some reasons were proposed for this apparent inconsistency, such as, adherence to NICE guidelines and ethical considerations when they are not consistent with cost-effectiveness principles, lack of funding for cost-effectiveness interventions, need for standardised comparable methods across cost-effectiveness studies, and issues with using a cost-effectiveness threshold value in the absence of a budget constraint.