Recent work has clarified the welfare implications of the application of cost-effectiveness analysis to the allocation of health care. Although cost-effectiveness analysis shares many similarities with cost-benefit analysis, it did not develop as an outgrowth of neoclassical welfare economics. Consequently, even though the welfare implications of public decisionmaking based on cost-benefit analysis have long been understood, until recently the conditions under which decisions made on the basis of cost-effectiveness criteria lead to potential Pareto improvement had received little attention. This chapter describes the welfare economic foundations of cost-effectiveness analysis and how such foundations can be applied to resolve controversies in the application of the technique. It also discusses procedures for applying the technique, the circumstances under which decision rules based on cost-effectiveness analysis have desirable welfare economic properties, the appropriate perspective for the analysis, and issues in measuring outcomes. Even when standard welfare economic assumptions are not fully accurate descriptions of the markets and conditions in which health care is delivered, cost-effectiveness analysis can be a useful guide to allocation decisions.
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