Cost-Effectiveness Analysis in Medicine and Public Health

EPI 213 Winter 2021 (2 or 3 units)
Course Director: Elliot Marseille, DrPH, MPP


In a world where policy-makers, donors, and payers are increasingly cost-sensitive, how does one measure returns on investments in health? Cost-effectiveness analyses can help formally evaluate clinical and policy decisions, particularly when, as is usually the case, decisions have to be made with incomplete or imperfect information. The objectives of this course are to give students an understanding of:

  • The use of, and practical guidance in the construction of, decision trees to portray alternative courses of action and their consequences;
  • Principles of cost-effectiveness analysis, including estimating costs, health outcomes, and metrics of cost-effectiveness;
  • Uncertainty in input parameters, and how this affects uncertainty in the results of cost-effectiveness analyses;
  • Sensitivity analyses, and their role in informing decisions in settings with imperfect information;
  • Markov modeling to portray the long-term costs and consequences of clinical and policy decisions;
  • Effective verbal and written communication of cost-effectiveness analyses;
  • Real-world examples of cost-effectiveness analyses that influenced clinical guidelines or health policy;
  • Specific challenges with cost-effectiveness analyses pertaining to low- and middle-income countries; and,
  • Critical review of published cost-effectiveness analyses.

The course is intended both for students who desire to perform a cost-effectiveness analysis on their own topic during the course (three-units course version) and for students who simply desire a general education in the topic of cost-effectiveness analysis but who do not wish to undertake their own cost-effectiveness analysis during the course (two-units course version).


Working familiarity with MS Excel, including navigation through a workbook and basic entry/copy/paste functions, and willingness to learn graphing and other functions.

Course Director:

Elliot Marseille, DrPH, MPP

Lecturer: James Kahn, MD, MPH
Teaching Assistant:

Albert Young, MD


There will be 6 core sessions on methods and 6 sessions focused on review of homework assignments and discussion of questions. These sessions will occur on Thursdays from 3:15 PM to 5:00 PM, Jan. 7 to Mar. 18.

The daily schedule of activities will be posted on the course's online syllabus.


The following textbooks are recommended but not required.

Methods for the Economic Evaluation of Health Care Programmes by M. F. Drummond et al. Oxford Medical Publications. 4th Edition. 2015.

Decision Modeling for Health Economic Evaluation by A. Briggs, M. Sculpher, and K. Claxton. Oxford University Press. First edition. 2006.

Books may be purchased either through the publisher or a variety of commercial venues (e.g.,

The course will be taught using Microsoft Excel software. However, those wishing to use TreeAge Pro software may do so. A trial version to evaluate TreeAge is available online. (Note that the trial version expires in 30 days; it may help to delay starting the trial till week 2 of the course). UCSF-based enrollees can access the software through MyResearch (you may have to request an account in advance). Other options include obtaining a student course license ($45, 6 months with limited options) and a student research license ($250, 1 year). Students will need one license per group project. Students who are proficient in MS Excel are welcome to build the model in that platform.


Students may enroll in either a two-unit or three-unit version of the course. The two-unit version is intended for those seeking an introduction to cost-effectiveness analysis but whom, at this time, do not desire to perform a cost-effectiveness analysis on their own topic or participate in a group project (focusing on an original cost-effectiveness analysis authored by one of the students). In the two-unit version, students will complete components of a cost-effectiveness analysis (on mammography screening) in which most of the inputs and other data will be provided by the instructors. The three-unit version will also provide an introduction to cost-effectiveness analysis but will also require students to participate in a group-based original cost-effectiveness analysis, whose topic will be initiated by one of the students in the course and whose inputs and data will be derived from the student group.

Two-unit version

Grades will be based on total points achieved in two cateogories:

  1. Homework (65%): Development of a cost-effectiveness analysis for mammography screening plus selected additional homework; and
  2. Project summary (35%): 600 word “research letter” format summarizing the cost-effectiveness analysis for mammography screening, presenting findings including 1 table and 1 figure.

Three-unit version

Grades will be based on total points achieved in three cateogories:

  1. Homework (45%): Development of a cost-effectiveness analysis for mammography screening plus selected additional homework. (Same as homework for the two-unit version); and
  2. Group project (30%): Assembly of inputs, analysis, and class presentation of a cost-effectiveness analysis on a topic derived from one of the students in the course. One or more groups will be formed depending upon the number of interested students. There must be clear delineation of individual roles students played during the project; and
  3. Project summary (25%): 600 word “research letter” format summarizing the group-derived cost-effectiveness analysis, including at least 1 table and 1 figure. This summary is to be written independently by each student in the group.

Students not in full-year TICR Programs who satisfactorily pass all course requirements will, upon request, receive a Certificate of Course Completion.

UCSF Graduate Division Policy on Disabilities


This course is sponsored by the Training in Clinical Research (TICR) Program, and space is limited. Preference is given to UCSF-affiliated personnel. We regret that auditing in the classroom is not permitted, but most of the course materials (with the exception of videotapes, answer keys, examinations, and copyrighted documents) are freely available (without formal enrollment) on the course’s online syllabus. Many students can glean the majority of the course’s content from this free access, but, importantly, formal enrollment also provides access to faculty for questions and individual-level extension of the curriculum, a community of other engaged students for in-person real-time discussion, and personalized correction and feedback on homework and projects.

To enroll in this course, please fill out and submit the application below. Please see our fees page for cost information. The deadline for application is December 2, 2020. Only one application needs to be completed for all courses desired during the quarter.

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