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I have recently been searching for earliest economic evaluations that
used cost-effectiveness analysis (CEA) for health-related decision
making. Most people attribute the first health-related applications to
papers in Medical Care from the late 1960s (e.g. Klarman?s paper on
the treatment of Chronic Renal Disease from Medical care in 1968).
However, I have recently found one intriguing reference to a US
defence report in the journal Science that predates this. The article
Civil Defense: Housing Reverses Direction and Approves Fallout
Shelter Program, Sequel from September 1963 discusses options for
fallout shelters to be used in the event of nuclear war:
"The heart of Pittman's [the then Assistant secretary for defence]
case was an ambitious cost-effectiveness study in the new McNamara
style, designed to show the life-saving potential of various kinds of
shelter in a variety of circumstances. Cost-effectiveness under a wide
range of attack conditions was determined by dividing the cost of
shelters by the number of lives presumptively saved by the
shelters."(p.1265)
Has anyone on the list ever seen this study? Can anyone suggest an
earlier application of CEA to a medical, or public health
intervention? If not, it would appear commissioning the first CEA is
one of Robert McNamara?s many contributions to public life (for those
unfamiliar with his others ? see the documentary ?The Fog of War?)
Cheers,
Philip
Dr Philip Clarke
PhD(ANU), MEc(Sydney), B.Ec
Senior Research Fellow
School of Public Health
Room 128B
Edward Ford Building (A27)
The University of Sydney
NSW 2006 Australia
Phone: +61 2 9351 5424
Fax: +61 2 9351 7420
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