Cost-Effectiveness Analysis in a Setting of Budget Constraints — Is It Equitable?

Budget constraints increasingly determine the provision of health care services. One of the promises of cost-effectiveness analysis is that it can demonstrate how to maximize the health care benefits attainable within a specific budget. 1 , 2 Despite this promise, cost-effectiveness analysis has been criticized for setting health care priorities in a way that violates people's values. 3 – 5 For example, many people value equity in the distribution of health care resources, yet equity is not accounted for in cost-effectiveness analyses. 6 – 13 A basic assumption of cost-effectiveness analysis is that one should always prefer a health care intervention that provides a population with . . .