Comparative Effectiveness
in Health Policy Decision
Making: A case study of costeffectiveness analysis for the Every
Woman Counts program
Joy Melnikow, MD, MPH; Daniel J Tancredi, PhD;
Dominique Ritley, MPH; Yun Jiang, MS; Christina
Slee, MPH
Svetlana Popova, MD, MPH;Philip Rylett, BSc
(Hons), RN Kirsten Knutson, MPH;Sherie Smalley,
MD
Funded by the California Program on Access to Care
Impetus
Cost-effectiveness analysis (CEA) can
project outcomes for public programs and
help to allocate limited resources in a
more efficient manner.
 Policy Question:

Given the increasing diffusion of more
expensive digital mammography, should the
EWC program pay for digital mammography
to improve access to services?
Case Study: EWC
Created a simple CEA for California’s
Cancer Detection Programs: Every
Woman Counts program:
 Used program-specific data and costs
 Compared the relative cost-effectiveness
of digital and film mammography
screening from the payer perspective.

Challenges
Policy changes during analysis cycle
 Claims data analysis:

 Not
structured for connected incidents of care
 No outcomes data except cancer registry
linkage

Balancing rigor and analytic complexity
with timeliness
Health Policy Implications

Simple CEA can provide evidence-based
information for policy makers
 Requires
collaboration for funding, expertise, and
data
 Standardizing program-specific approaches in the
future may help reduce challenges to timeliness and
rigor of the models
 Once a program-specific model is created, repeated
adaptation and application will be more efficient