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To the Editor: In their Special Communication, Drs Pearson and Rawlins¹ discuss ways in which the United States could adapt the British National Institute for Health and Clinical Excellence (NICE) to the US context. They are building on earlier suggestions by Woolf,² Bailit,³ and others to create an independent organization to help policymakers assimilate best evidence, which is strongly supported by the Ethical Force Program.⁴

But their central point that the United States must explicitly incorporate costs into coverage decisions is too narrow. Too many US citizens misunderstand and mistrust the complex and often opaque systems through which coverage decisions are made. Simply increasing the use of cost-effectiveness analyses (CEAs) to inform these decisions—no matter how well the CEAs are done—will not enhance understanding and trust in coverage decisions, given the complexity of these decisions and the acknowledged limitations of CEAs.⁵ Increased use of CEAs, without a concurrent comprehensive attempt . . . [Full Text of this Article]

Matthew Wynia, MD, MPH
matthew.wynia@ama-assn.org
Institute for Ethics
American Medical Association
Chicago, Ill

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Cost-effectiveness Analysis in the United States—Reply
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