Technology assessment and cost-effectiveness analysis: misguided guidelines?

Laupacis and associates in their proposed “tentative guidelines” for the economic evaluation of new technologies, recommended that the incremental cost-effectiveness rations of new technologies be used to determine which technologies merit adoption and funding. Their work is timely and provocative, given the current fiscal crisis in Canadian healthcare. Unfortunately, that same fiscal crisis may lead policymakers and physicians to embrace these guidelines prematurely for rationing clinical services. Although we do not take issue with the use of cost-effectiveness analysis to assist in making policy decisions, we have concerns about the proposal.