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