Cost and economic evaluations, if successfully implemented, should produce valid data and insight about the efficiency of HP-DP programs. They define program costs and what it will cost to break even, if a new intervention is introduced. CBA defines the potential or actual opportunity to save money. Efficiency of intervention methods in producing either behavioral impact-health outcome rates described in non-monetary terms, or impact or outcome rates described in dollars, should be documented using the appropriate analyses. Conducting economic evaluations of HP-DP methods should be a routine process for HP-DP programs. Many funding agencies require a cost-economic evaluation for all major HP-DP proposals.

The Congressional Office of Technology Assessment concluded in 1981 that healthcare decision-making could be significantly improved by the process of identifying relevant costs and benefits of a decision and policy. While a voluminous body of literature and evidence confirms the validity of this 30-year-old statement, past and present reports indicate that cost-economic analyses and evaluations are typically not part of an HP-DP program plan or its evaluation. CEA or CBA are infrequently part of an evaluation of public health or primary care services.

It is also important to emphasize from a philosophical perspective that a preoccupation with cost analyses and solely judging a program’s economic value-cost is usually not justifiable. Cost-economic evaluation, for most programs, should seldom serve as the primary determinant of HP-DP program decision-making. Cost and efficiency are only one part of rational decision-making. A broader range of issues, especially effectiveness, quality, and equity, reflecting concern for the health and welfare of a target population, should be the primary guides to decision-making.

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