On my mind with Josh Cohen, PhD

Whether science, law, or health economics, it (should be) evidence-based

Health economics is a branch of (social) science, and the sine qua non of science is replicability: in concept, papers describe their methods so that an observer might independently evaluate the evidence, replicate the work, and reach the same conclusion.  Law is similar.  An observer should be able to follow an argument’s logic, supporting precedents, and evidence, and potentially reach the same conclusion.  Compared to law, however, health economics seems to fall short of this “evidence-based argumentation” standard in practice.  

I recently selected an arbitrary cost-effectiveness analysis published in the Annals of Internal Medicine.  It appears to have been well-conducted, but reconstructing the analysis would be challenging.  For example, the article described the evidence for an assumed treatment cost by tersely referencing six articles and explaining that the authors averaged costs from three and used a median value obtained via a personal communication.(1)  It is unclear what information the other three articles contributed.  Even if it is possible to reproduce the reported estimate’s calculation, the authors could have made it considerably more obvious.  (Space was no constraint, as this information appeared in an online supplement.)

A randomly selected article in the Boston University Law Review reveals substantially more documentation.(2)  Footnotes paraphrase how a source supports a proposition and often specify the pages where that support appears.  Discussing the article publication process with one of the journal’s managing editors, I learned that editors check every sentence in a manuscript to ensure that it has support, and that documentation is explicit, specific, and clear. 

This process is labor intensive – hence the dozens of editors appearing on a law review’s masthead, all of whom are students “paid” with experience and professional recognition.  That model is unavailable in our field.  Nonetheless, it seems that health economics would benefit from adhering to a similar standard.  Authors would need to spend more time on documentation, but by being able to independently evaluate the connection between the cited evidence and its use, we could all have greater confidence in the resulting work. 



(1)        Laprise JF, Chesson HW, Markowitz LE, Drolet M, Martin D, Bénard É, Brisson M. Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States. Ann Intern Med. 2020 Jan 7;172(1):22-29.  See Appendix Table 1, entry for healthcare costs of anogenital warts, including table footnote.

(2)        Bagchi A, Lowering the Stakes of the Employment Contract, 102 B.U. L. REV. 1185 (2022).

On my mind with Josh Cohen, PhD

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