ABSTRACT
The discussion of problems in the measurement of costs and benefits aims to make people cautious in the use and interpretation of economic evaluation studies. However, much can be learned from careful and sensible use of economic evaluation of health interventions. The most important starting point is to ensure that the evaluation is concerned with the right, or at least sensible, questions. Several principles are important. First, the objective should normally be defined in terms of achievement that matters rather than wellintentioned effort. The objective should always be to get as close as possible to ‘output’ while recognising that that is often difficult. Different ways of reducing infant mortality can reasonably be compared. Different ways of providing continuing care to terminally ill people may be subjected to evaluation. The point is that we can be clear about the objectives. In the first case we want low infant mortality, and in the second we want goodquality care. In contrast, we can only set the number of appendicectomies as an objective if we are sure that more would be better –in other words, that the current rate of the procedure means people are suffering or dying
for want of this treatment. If this is not the case, one can still evaluate whether or not there are lower-cost methods of achieving the same rate of appendicectomy but need to be very careful not to fall into the ‘more is better’ way of thinking.
