Measuring Cost-Effectiveness in Palliative Care

There is a simple logic to cost-effectiveness analysis. We cannot individually or collectively provide all possible health and social care services (just as few of us are able to buy all housing and holidays we would like) so the best strategy is to provide those services that yield the best value for the resources used. This involves assessing the costs and benefits of all potentially useful services and choosing those that provide the best value. However, especially in the case of services such as palliative care, there are challenges in measuring and valuing benefits. In our normal lives, we choose to use our resources on goods and services that provide us with the greatest benefits. Similarly, collectively in principle, we should give priority to those services that give the best return. Priorities should be set in order of the ratio of benefits to costs (since this rule provides the highest gains for any level of spending). In principle, it does not matter who the payer is—we should not choose to buy ourselves any services that are not worth the cost; insurance should not cover services that are poor value for money; governments should only fund services where benefits exceed the costs; and for any given budget, any decision-maker should prioritize those choices that provide the greatest value.