Post on 01-Jan-2016
description
BY USING TWIGS, MY DESIGN IS MORESTRUCTURALLY SOUND THAN STRAW, YET MORE COST-EFFECTIVE THAN BRICK.
George A. Diamond, MD
Cost-Effectiveness
A Moral CalculusPE Ratio = Price / EarningsLP ratio = LDL / HDL
CE Ratio = Bad / Good
Cost-Effectiveness
CE Ratio = Bad / Good
How much will it cost?
How many will it help?
Cost-Effectiveness
CE Ratio < $ 5 0, 0 0
0
CE Ratio < $ 5 0, 0 0
0Rank State Per-Capita Income*
1 Connecticut $45,506
28 Texas $30,697
50 Mississippi $24,379
U.S. Average $33,041
* 2004 (www.bea.gov)
Cost-Effectiveness
Rank Country Per-Capita Income*
5 United States $33,070
18 Canada $20,790
47 Mexico $5,179
World Average $5,003
* 2004 (www.nationmaster.com)
CE Ratio < $ 5 0, 0 0
0
Cost-Effectiveness
Arbitrary Why not per capita income?
Parochial Why a single value?
Deceptive Why a ratio?
Irrelevant Who cares?
CE Ratio < $ 5 0, 0 0
0
Cost-Effectiveness
Cost-Effectiveness
Nitroglycerin Stenting
CE Ratio = $100 CE Ratio = $100,000
CE Ratio < $ 5 0, 0 0
0
The Good . . .
Cost-Effectiveness
How many will it help?
The Good, the Bad . . .
Cost-Effectiveness
How many will it help?
How much will it cost?
The Good, the Bad, and the Ugly
How many will it help?
How much will it cost?
How do we pay for it?
Cost-Effectiveness
Cost-Effectiveness
Treat TestTreat
Target Population 50,000,000 10,000,000
Expected Events 500,000 400,000
Annual Cost $5 Billion $6 Billion
Prevented Events 150,000 120,000
The Good, the Bad, and the Ugly
Cost-Effectiveness
Treat TestTreat
Target Population 50,000,000 10,000,000
Expected Events 500,000 400,000
Annual Cost $5 Billion $2 Billion
Prevented Events 150,000 120,000
The Good, the Bad, and the Ugly
Cost-Effectiveness
IS FOR
George A. Diamond, MD(Apologies to) AMBROSE BIERCE
A pseudo-scientific moral calculus
permitting the fabrication of clinically
irrelevant post-hoc justifications for
otherwise indefensible preconceived
notions
Ghandi Ghoofi