, Volume 24, Issue 11, pp 1121–1131 | Cite as

Information Created to Evade Reality (ICER)

Things We Should Not Look to for Answers
  • Stephen Birch
  • Amiram Gafni
Conference Paper


Cost-effectiveness analysis has been advocated in the health economics methods literature and adopted in a growing number of jurisdictions as an evidence base for decision makers charged with maximising health gains from available resources.

This paper critically appraises the information generated by cost-effectiveness analysis, in particular the incremental cost-effectiveness ratio (ICER). It is shown that this ratio is used as comparative information on what are non-comparable options and hence evades the reality of the decision-maker’s problem. The theoretical basis for the ICER approach is the simplification of theoretical assumptions that have no relevance to the decision maker’s context. Although alternative, well established methods can be used for addressing the decision maker’s problem, faced with the increasing evidence of the theoretical and empirical failures of the cost-effectiveness approach, some proponents of the approach now propose changing the research question to suit the approach as opposed to adopting a more appropriate method for the prevailing and continuing problem.

As long as decision makers are concerned with making the best use of available healthcare resources, cost-effectiveness analysis and the ICER should not be where we look for answers.


Decision Maker Incremental Cost Health Gain Mathematical Programming Technique Marginal Opportunity Cost 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this article. The authors have no potential conflicts of interest that are directly relevant to the contents of this article.


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Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonCanada
  2. 2.University of ManchesterManchesterUK

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