Abstract
Medical technology assessment, which traditionally has involved evaluating whether a technology was safe and effective, has been expanded in recent years to include consideration of cost-effectiveness. While most analysts and policymakers would agree that cost-effectiveness is, in principle, a worthy goal, actually using such a standard in coverage decisions is much more difficult. This Commentary focuses on challenges involved for public payers and what we can realistically expect a cost-effectiveness criterion to accomplish. First, we briefly discuss the cost-effectiveness principle. Second, we address some of the key issues in asserting medical technologies. Finally, we discuss both the opportunities and limitations of cost-effectiveness analysis.