What Counts in Economic Evaluations in Health? Benefit-cost Analysis Compared to Other Forms of Economic Evaluations

Economic evaluations are increasingly popular, both in the field of global health as well as in purely domestic settings. However, the proliferation and use of economic evaluations by members of multiple publics, many of whom are non-economists, creates misunderstandings as well as strategic opportunities. In this extended essay, Lauer and colleagues develop a critical analysis of economic evaluations that is intended to clarify concepts and terms, and thereby to enable a diverse community of users, performers, and commissioners of economic analyses in health to better understand and use such studies. The authors pay particular attention to cost-effectiveness analysis, long the mainstay of economic evaluations in health, and to benefit-cost analysis. The article starts by noting that economic evaluations in health (EEHs) take a number of typical forms, although all involve a comparison of inputs and outcomes, either of which may or may not be market-traded goods. They call a particular choice of inputs and outcomes a ‘table of accounts’. They argue that the notion of a table of accounts provides a useful way to understand the methodological diversity of EEHs, one which subsumes more established but also more restrictive terminology (e.g. the notion of ‘study perspective’). Lauer and colleagues present tables of account for a number of commonly used EEHs. They then discuss at length benefit-cost analysis, a distinctive form of EEH that has recently attracted substantial attention in the form of so-called ‘investment cases’ in health