BOOKS OF RtfiDIfGS - PAHO/WHO

"'ol. XVIII, Nu. II1
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(:CST.BENEFIT AND) COST-EFFECTIVENESS
cess of benefits over costs? Because ,il
costs and benefits are measured in the
same (inonetary) unit, CBA can lie
employed to compare similar or widely divergent
types of programs. Thus. in theory
at least, CBA might be used to decide
whether publie resourees should be allocated
to construction of a dam or constniction
of a hospital.
In CEA, desirable program consequen¢es
are not valued in monetary tenni,
but rather arte measured in some other unit;
in health care CEAs. cominon nmeasures
include years of life saved and days ol' inorbidity
or disahility avoided. The reasoní lor
a iaoninoetariy mcasure of l prgranil tieLctiveuness
is .. ither the in)p.ossil)ilit or .uudesirability
of valuing imnportaiit onitel mei. e
in dollars. Thus. thte " lottoiI h¡m." a
CEA is not. lilke a C(BA. a nel nlt i.la'Lry
value; rather. it is expretssed iii Uiaits liike
"dollars per year of lilf saved." CEA ipermits
eo'niparison of e.ost per unil (itf eot.leetivriness
anolng conilx'ting progralla alte'rnat1;
.. .1, -. 'ifd to serne the salie I)asi('
purpose, biut unlikel CBA it des inot allou
em)lllaristil fe I)r prgrasail, ¡lailag dliltere(tlt
oDieotives. I)ca(.ise thle etli etlr'.lv', , , r
eouitenilue uaí.'eieres ditl'r. Nor dI.'s it I¡. riit
assessmiient of t Il. inhil, renit .rhl nl .ifa
progranli: is a c .si ol'S($.5O().0r(J >t'r or lih-.
sas;ved auteltal)le? ()lvioisly. tlis ilue · -
tion reqjlires a sowial iind piolitivall jmdg-
Ilmena:; it i ¡¡iot sililyll .h lic.il ..ner.
(:BA andl (:iEA,:I lJa I 'v'tl sti.iedl ¡lr
dlev-ad.(%. b)y cntrib)utions
appeared in print, with the exeeption
of a chapter by Grosse4 in a 1970
book n.;iented toward stiidents of
econoumiies and policy analysis. This chapter
is parti':ularly noteworthy Icr its reiew
ofí C:A/CEA applications in tll,. Departmeni
of l.ahlth, Education, antd 'elll'are
(HEW) during the author's tc, uure as all
HEW fllicial. Grosse cun)eyed miiIlh of
thi' samle lmaterial in ani article publishedl 2
years later/ though agairi tie audience was
o¡it heallth care p)rnt'ssioaiais. That same
year. houweer. witnessed p>ulblicatioi of a
h),>,k which I )h'anie one of the health care
c milsi¡"íity's mniost widely read asd fre-
(lueIntl cited contributions, Coxhrane's
Effe¿tlrm ene*s url EI:ffirideny: Randonr Reflie
icS,'i * o> Ilulthl Ser.tit'(e." lil o)lur e(StirIllntlll
this short IJxx)k hadl a i)roil(aimd inpa¡lt
ii tlanling the' thouuglhts olf hiealtia care
prol.s.aicinalis toward issties of resource
scareity and thie link ewtweeln eflicieley
anlid vq'ily. It is at least possilleh that (:Kehti.me'.s
I>,c>k pliared a sigilgniftiat rle iii til'
ralpid grousth irn healti cvare (:BA/(:IEA
wh lvla I('ganm tile -fcitoewiig yvar.
I¡i !971J. Klarmlan pul)lished twu- articlehs
.ia CHA . iethodlioh,el. . and al)pllicationis.
()1 ' 1,s fil-' Iist a tti.n cit(led re- it.' al.Ld l ;s-
( ,%-i>ii el th'athh -. care (:A/(:I'EA'. li.he
,pll¢'r ;,vs tli'. firt se,1 ii .prtpll ' let al)i)¢e-11 il
.1 Ilmedlí..l lOlill.icl I 'lI' h teolissin ye'air.
1),IhI. ", I¡ hhsh' .,I t