Dear Carlos
The attitude to cost-effectiveness is an interesting contrast to data on
NNT - which often dampens the enthusiasm of clinicians, patients, and
policy makers.
SO my guess is that we don't like putting a cost to a treatment that is
a certain success (NNT = 1), but that we (all 3 groups) are less
enthusiastic when there is a low chance of benefit.
I've often wondered whether policy makers and economists would do better
to use NNT (which is easy to understand) rather than the arcane cost per
(discounted) QALY?
That would shift the focus from cost thresholds to small benefits, which
folk might be more comfortable to forgo.
Cheers
Paul Glasziou
Dr. Carlos Cuello wrote:
> Interesting reading this survey from Mayo published in the NEJM; over
> half of physicians reported a moral objection to using
> cost-effectiveness analysis data.
>
> http://bit.ly/10kx4Q
>
> complete link: http://healthcarereform.nejm.org/?p=1785
>
>
> Any comments?
>
>
> PS and Disclaimer.- Reason for being interested in this subject: I am
> writing an essay about what lessons can we in Latinamerica learn from
> the US health care reform as well as from how other healthcare systems
> are practiced around the world to achieve equity and quality in
> healthcare.
>
> --
> Carlos A. Cuello-García, MD
> Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey
> Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical
> Research
> Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er.
> piso,Monterrey NL, México. CP64710
> Phone. +52(81)88882154 & 2141. Fax: +52(81)88882019
> www.cmbe.net <http://www.cmbe.net>
> http://twitter.com/CharlieNeck
>
> The content of this data transmission must not be considered an offer,
> proposal, understanding or agreement unless it is confirmed in a
> document signed by a legal representative of ITESM. The content of
> this data transmission is confidential and is intended to be delivered
> only to the addressees. Therefore, it shall not be distributed and/or
> disclosed through any means without the authorization of the original
> sender. If you are not the addressee, you are forbidden from using it,
> either totally or partially, for any purpose
--
Paul Glasziou
Director, Centre for Evidence-Based Medicine,
Department of Primary Health Care,
University of Oxford www.cebm.net
ph - +44-1865-289298 fax +44-1865-289287
|