For All Decision Makers
Getting Value for Money
As a society, sooner or later we will have to determine whether there are some ben-
efits that are just too small to justify the cost. —David Eddy, MD1
SO FAR, we've focused mainly on treatments that turned out to be useless, that did more harm than good, or that were both less effective and more expensive than alternatives. In cases like these, it's easy to decide against routinely using the new treatment. No sensible person wants ineffective or harmful treatment. No one wants a more expensive treatment if a less expensive one is just as good. If we were more discriminating in the use of these treatments, we'd save billions every year.
But more common, more challenging, and more painful is the situation where a new treatment has some very small advantage over alternative treatments, but at a very high price. The number of such treatments is enormous, and we're definitely paying for them. Most of us would agree that an expensive new treatment is worth the added cost if there's a big bang for the buck. We don't mind rising health-care costs when the benefits are substantial. We're not necessarily looking to save money on health care, just to get value for our money.