Government and society

At the highest level of aggregation, economic evaluations can and should influence government policy and resource allocation decisions. For example, such evaluations have influenced policy with respect to the reprovision of care for the long-term mentally ill from hospital to community settings, (44> the development of 'assertive community treatment' models for acutely ill people (see above), the organization of services (through care management perhaps), and the overall level of funding.

While the addition of economic analysis to mental health-care evaluations introduces an extra dimension that offers a wider assessment of the implications of new or existing courses of action, it is important also to mention some of the limitations of the approach. Many economic evaluations fall short of the ideal, whether that be in terms of sample size, comprehensiveness of cost, outcome measurement, or evidence interpretation. Conclusions based on a small-sample randomized trial can often only be tentative, while the failure to measure the wider (non-health and non-service) costs associated with two or more alternative treatments may produce misleading results. There are also a number of ongoing methodological debates with respect to certain aspects of economic evaluation, such as the alternative techniques available for measuring health state preferences (essential for both cost-utility and cost-benefit analyses).

Even without these limitations, economic evaluation cannot be a panacea for making difficult allocative and policy decisions; rather, it is one additional tool that, together with evidence on the clinical and social dimensions, can facilitate explicit evidence-based decision-making.

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