Common descriptions of health technology assessment (HTA) suggest that it should consider, amongst other things, the economic implications of the development, diffusion and use of health technologies. The economic implications are important as the resources available for health care are limited and they have many alternative beneficial uses. Economics provide a means of informing these choices. It does this by considering whether the benefits we get from using the resources one way are greater than the benefits we might obtain if they were used in another desirable way.
Often however the new technologies considered within an HTA are more costly but more effective than the services that they seek to replace. Judgements about whether the more effective and costly intervention are worthwhile are often based upon the value taken by the incremental costs per unit of health effect (the incremental cost-effectiveness ratio (ICER)). The higher the ICER the less likely it is that the new intervention will be considered worthwhile. If a more costly but effective intervention is considered to be worthwhile then when faced with a limited budget hard decisions have to be faced about which services will need to be reduced to free up resources to provide the new intervention. In this talk I explore using an example of an HTA on laparoscopic surgery for colorectal cancer the implications to health budgets and the need to consider both the ICER, the information on which the ICER is based as well as other economic factors that may not have been included in the ICER (e.g. the costs of training, the value patients may put onto the process of care rather than the just the outcomes).