Costs in economic assessment of health care

This paper aims at questioning the concept of cost as it is used by economists, specifically by health economists dedicated to the evaluation of health care. This concept is an artificial elaboration, rooted in the so called marginalist theory, and one can say that there exists nothing like a cost of a good. In fact, different conceptions of what should be called a cost exist, and an evaluation exercise should state which notion it elaborates on. This basic choice, if not stated, explains why evaluation often seems to be a fragile series of arbitrary decisions leading to unexplainable discrepancies. Specifically, we claim that standard pharmacoeconomics is not well adapted when specific resources or public goods are used in the production process. Therefore, the art of evaluation consists in choosing the best fitted method according to the context and the object at stake.