Weighing risks, benefits and costs: cost-effectiveness
- Topic
Comparing benefits with risks and costs is part of doing good; economic analyses help, but they do not replace judgements of justice.
What it is
Beneficence asks us to compare what an option can give with what it can cost. In the consultation, risk-benefit analysis looks at the probability and size of the benefits and harms for that patient; the number needed to treat (NNT) and the number needed to harm (NNH) translate this into people. In health policy, economic evaluations are used: cost-effectiveness (cost per unit of outcome, such as a life saved), cost-utility (cost per QALY) and cost-benefit (everything in money, including life). They inform hard decisions, because every peso spent on one thing is no longer available for someone else (opportunity cost). But they do not, on their own, answer the question of justice: whom to benefit first. The resource allocation page covers that distribution.
Key facts
- Types of economic evaluation: cost-minimization, cost-effectiveness, cost-utility and cost-benefit.
- Incremental cost-effectiveness ratio: the difference in costs between two options divided by the difference in effects.
- Ethical problems: which costs count (patient, family, system), discounting future benefits, adding up benefits without looking at who receives them, and putting a price on life.
- Economic evaluation informs; the decision also weighs equity, need and priority to the worst off.
- At the bedside there is no hidden rationing: limits are set with public, reviewable criteria.
Types of economic evaluation
| Type | Measures the outcome in | Question it answers |
|---|---|---|
| Cost-minimization | Equal outcome between options | Which costs less if both work equally well? |
| Cost-effectiveness | Natural units (lives saved, cases prevented) | How much does each unit of outcome gained cost? |
| Cost-utility | QALYs | How much does each quality-adjusted life year cost? |
| Cost-benefit | Money | Are the benefits worth more than the costs? |
In clinical practice
- Explain benefits and harms in the same units: «out of 100 people treated, 5 avoid a heart attack and 2 have a bleed».
- An expensive treatment with marginal benefit is discussed honestly with the patient, neither hidden nor imposed.
- Ordering tests or procedures that will not change management exposes the patient to risks without benefit.
- Under pressure to «do everything» in a highly visible case, remember the rule of rescue and opportunity cost.
Legal framework in Colombia
- Ley 23 de 1981, art. 15: do not expose the patient to unjustified risks; art. 10, parágrafo: do not demand unnecessary tests or treatments that are not justified.
- Decreto 3380 de 1981, art. 9: unjustified risks are those to which the patient is subjected that do not correspond to their clinical and pathological condition.
- Ley 1751 de 2015, art. 15: excludes from public funding what lacks evidence of clinical safety, efficacy or effectiveness, what is not authorized, what is experimental, what is cosmetic and what must be provided abroad.
- Official texts checked on 2026-11-13 at minsalud.gov.co and normograma.supersalud.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
How does a cost-utility analysis differ from a cost-benefit analysis?
Cost-utility measures the outcome in QALYs; cost-benefit expresses everything in money, including life.
What is opportunity cost in health?
What is no longer done for other patients with the resources spent on one intervention.
How does Decreto 3380 de 1981 define unjustified risks?
As those to which the patient is subjected that do not correspond to their clinical and pathological condition (art. 9).
Why is a cost-effectiveness analysis not enough to decide?
Because it adds up benefits without looking at who receives them; the decision must also weigh equity, need and priority to the worst off.
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Connections
Educational content on ethics and health law; not legal advice. Laws and case law change: each page links the official text and says when it was last checked. For a real case, read the text in force and ask a lawyer or the medical ethics tribunal.
Sources: Making Choices in Health: WHO Guide To Cost-Effectiveness Analysis (World Health Organization, 2003); Chapter 20: Economic evidence (Cochrane, 2024); Ley 23 de 1981, por la cual se dictan normas en materia de ética médica (Ministerio de Salud y Protección Social, 1981); Decreto 3380 de 1981, por el cual se reglamenta la Ley 23 de 1981 (Superintendencia Nacional de Salud, Normograma, 1981); Ley Estatutaria 1751 de 2015, que regula el derecho fundamental a la salud (Superintendencia Nacional de Salud, Normograma, 2015).
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Representative model, for educational purposes only.