Patient experience – the ingredient missing from cost-effectiveness calculations

David CurtisCentre for Psychiatry, Barts and the London School of Medicine and Dentistry, London, UKAbstract: Standard cost-effectiveness calculations as used by the UK National Institute of Clinical Excellence compare the net benefit of an intervention with the financial costs to the health service. Debates about public health interventions also focus on these factors. The subjective experience of the patient, including financial costs and also transient pain, distress, and indignity, is routinely ignored. I carried out an Internet survey which showed that members of the public assign a high financial cost to routine medical interventions such as taking a tablet regularly or attending a clinic for an injection. It is wrong to ignore such costs when attempting to obtain an overall evaluation of the benefit of medical interventions.Keywords: screening, prevention, financial cost, medical interventions