The role of health economics in clinical decision-making: is it ethical?

With health care resources inevitably limited, we must ensure that they are used where they will do the most good. Doing good means improving people's life expectancy and quality of life, two characteristics which are combined in the Quality-Adjusted-Life-Year, or QALY. Even with effectiveness measured in this humanitarian way some people think it is unethical to let cost-effectiveness notions guide health care priorities. But costs represent sacrifices of health imposed on others, and it cannot be ethical to ignore such sacrifices. Indeed the reverse is true, it is unethical to ignore costs, and not to seek to become more efficient.