Cost-effectiveness considerations in critical care.

The ICU, perhaps more than any other area in modern medicine, brings the conflicting issues of high cost and life-saving technology into stark relief. Cost-effectiveness analysis offers a quantitative method for selecting among treatments to optimize outcomes for any given financial outlay. Impediments to developing and using cost-effectiveness analysis to guide medical care decisions include the lack of accurate estimates or treatment effectiveness and reliable cost measures; variations in assumptions used in different cost-effectiveness analyses; and lack of an ethical or regulatory construct to ensure that the decisions will be carried out fairly. Recently, standards for performing cost-effectiveness analyses have been proposed which should enhance the quality and comparability of studies. A detailed understanding of the methods and limitations of economic analyses is essential to clinicians challenged by a growing number of articles and manufacturers' claims regarding the cost-effectiveness of critical care.