Strengthening Cost-Effectiveness Analysis for Public Health Policy

Am J Prev Med. 2016 May;50(5 Suppl 1):S6-S12. doi: 10.1016/j.amepre.2015.11.007.


Although the U.S. spends more on medical care than any country in the world, Americans live shorter lives than the citizens of other high-income countries. Many important opportunities to improve this record lie outside the health sector and involve improving the conditions in which Americans live and work: safe design and maintenance of roads, bridges, train tracks, and airports; control of environmental pollutants; occupational safety; healthy buildings; a safe and healthy food supply; safe manufacture of consumer products; a healthy social environment; and others. Faced with the overwhelming array of possibilities, U.S. decision makers need help identifying those that can contribute the most to health. Cost-effectiveness analysis is designed to serve that purpose, but has mainly been used to assess interventions within the health sector. This paper briefly reviews the objective of cost-effectiveness analysis and its methodologic evolution and discusses the issues that arise when it is used to evaluate interventions that fall outside the health sector under three headings: structuring the analysis, quantifying/measuring benefits and costs, and valuing benefits and costs.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Cost-Benefit Analysis / economics*
  • Health Policy / economics*
  • Humans
  • Public Health*
  • Quality-Adjusted Life Years