Cost-effectiveness ratios: in a league of their own

There is an increasing tendency for papers appearing in the medical literature to propose or use league tables of cost-effectiveness ratios as a means of comparing health-care interventions. In this paper we identify what the information in cost-effectiveness league tables tells us and how this is inadequate and inappropriate for addressing questions about improving efficiency in the use of resources at either the broad system level or at the individual care-group level. We present an alternative approach which provides decision makers with a practical way of deciding whether the adoption of a particular programme represents an unambiguous improvement in economic efficiency.