This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Epstein, D. M. Articles by Sculpher, M. Search for Related Content PubMed PubMed Citation Articles by Epstein, D. M. Articles by Sculpher, M. Social Bookmarking                         What's this?

Efficiency, Equity, and Budgetary Policies

Informing Decisions Using Mathematical Programming

Centre for Health Economics, University of York, York, UK

Zaid Chalabi, PhD

London School of Hygiene and Tropical Medicine, London, UK

Karl Claxton, PhD

Centre for Health Economics, University of York, York, UK

Mark Sculpher, PhD

Centre for Health Economics, University of York, York, UK, dme2{at}york.ac.uk

The standard decision rules of cost-effectiveness analysis either require the decision maker to set a threshold willingness to pay for additional health care or to set an overall fixed budget. In practice, neither are generally taken, but instead an arbitrary decision rule is followed that may not be consistent with the overall budget, lead to an allocation of resources that is less than optimal, and is unable to identify the program that should be displaced at the margin. Recent work has shown how mathematical programming can be used as a generalization of the standard decision rules. The authors extend the use of mathematical programming, first to incorporate more complex budgetary rules about when expenditure can be incurred, and show the opportunity loss, in terms of health benefit forgone, of each budgetary policy. Second, the authors demonstrate that indivisibility in a patient population can be regarded as essentially a concern for horizontal equity and represent this and other equity concerns as constraints in the program. Third, the authors estimate the different opportunity costs of a range of equity concerns applied to particular patient populations, and when imposed on all patient populations. They apply this framework of analysis to a realistic and policy-relevant problem. Key words: cost-effectiveness analysis; cost-benefit analysis; mathematical programming; resource allocation. (Med Decis Making 2007;27:128—137)

Medical Decision Making, Vol. 27, No. 2, 128-137 (2007)
DOI: 10.1177/0272989X06297396


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. Griffin, K. Claxton, and M. Sculpher Decision analysis for resource allocation in health care J Health Serv Res Policy, October 1, 2008; 13(suppl_3): 23 - 30. [Abstract] [Full Text] [PDF]