Abstract
The principle of extended dominance is applied in incremental cost-effectiveness analysis to eliminate from consideration strategies whose costs and benefits are improved by a mixed strategy of two other alternatives. Ethical considerations arise, however, in that equal care is not provided to all of the population. To explore these concerns, the authors establish a theoretical health care example with three diagnostic strategies. They demonstrate, both algebraically and geometrically, how to calculate the set of all possible mixed strategies that dominate the strategy eliminated by extended dominance. With the consideration of budget constraints, they define the "coefficient of inequity" as the minimum proportion of the pop ulation that would receive an inferior health care strategy if a mixed strategy were to be used instead of the dominated strategy. The implications of cost-effectiveness analysis are made explicit, revealing classic economic concerns about the tradeoff of equity and efficiency. Key words: cost-effectiveness analysis; extended dominance; economics; ethics. (Med Decis Making 1994;14:259-265)
Reference9 articles.
1. Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical Decision Analysis. Philadelphia : W. B. Saunders, 1980, p 260.
2. Economic Assessments of Medical Practices and Technologies
3. Raiffa H., Schwartz WB, Weinstein MC Evaluating health effects of societal decisions and programs. Decision Making in the Environmental Protection Agency (Vol. IIb, National Academy of Sciences, 1977), 1-81.
4. Managing a Low-Incidence Risk: The Example of Toxic Shock Syndrome
Cited by
120 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献