Author Marthe Gold, MD, MPH, is a Senior Scholar in Residence at The New York Academy of Medicine and Professor Emerita at the City College of New York. Her co-author Steven M. Teutsch, MD, MPH, is a Senior Fellow at the Public Health Institute at the UCLA Fielding School of Public Health.
National health expenditures represented nearly 18 percent of the U.S. gross domestic product (GDP) in 2015, while efforts to limit cost growth continue to be central objectives for public and private payers alike. Dissemination of research on the evidence base for clinical practice is an important strategy for persuading policymakers, providers, and patients that some things in medicine are not worth doing: they create too much risk, have unacceptable side effects, lack adequate effectiveness, and even, occasionally, that they are too costly for the benefits they confer. Evidence on the latter is derived from cost-effectiveness studies that allow comparison of the value for money of an intervention or program when compared to one or more alternative health-promoting interventions.
The use of cost effectiveness analysis (CEA) in U.S. policy-setting environments has a checkered history given perceptions that the methodology lacks transparency, that it is applied to some interventions and not others, and that it would be used to support health care rationing. Nonetheless, the annual publication of CEAs has increased more than 10 fold since the 1990s, the lion’s share of which have been studies of the cost-effectiveness of clinically delivered prevention and treatment services. Studies that focus on non-clinically directed health promoting interventions such as tobacco or sugar taxes, or placement of urban greenways are in short supply in spite of the fact that a robust literature has documented that health care’s impact on population health is dwarfed by social and environmental factors.