Choosing between competing health priorities. A government payer perspective.

Policy makers in developed countries are increasingly having to look at how they are to control the cost of healthcare in the face of the pressures of an aging population, the introduction (and cost) of new technologies and the increasing expectations of patients. To some extent, costs can be contained by concentrating on those technologies with proven clinical effectiveness. However, if priorities have to be set, some method of appraisal of the relative values of different interventions is required. Increasingly, economic analyses are being used to justify policies and the use of resources, by introducing measures of cost and quality as well as effectiveness. Those economic evaluations most commonly used, and their shortcomings, are described. Priority setting cannot, however, be reduced to a purely technical exercise. Decisions on what should and should not be funded from the public purse will be influenced by the overall framework of national aims and objectives and by professional opinion and public values; they will be more firmly based and defensible if they are subject to wide public discussion and debate.