Beyond the Basics of Cost-Effectiveness Methods: Advanced Methods for Surgical Decision-Making

INTRODUCTION: As the scope and goals of health care evaluation expand, traditional cost-effectiveness analysis (CEA) methods, which typically evaluate interventions based on their cost per quality-adjusted life year gained, often fall short in capturing the real-world complexities of surgical decision-making. Building on our companion article on foundational CEA, there is an increasing need for advanced analytic tools that incorporate uncertainty, system constraints, and equity considerations. METHODS: In this article, we explain a curated set of advanced methods building on our companion introductory article. These include value of information analysis, discrete event simulation, and equity-informative economic evaluations (including distributional and extended CEA). For each method, we describe the underlying analytic framework, explain its relevance to real-world surgical decision-making, and illustrate its application using published examples from surgical or health policy contexts. RESULTS: These methods enhance the relevance and interpretability of economic evaluations by enabling analysts to quantify the value of future research, simulate care delivery in resource-constrained systems, and incorporate equity concerns into economic decision-making. A summary table compares the full suite of methods across both explainers for ease of reference. CONCLUSIONS: Advanced CEA methods provide important tools for addressing challenges in modern surgical and policy decision-making. This explainer aims to equip surgeons and surgical health services researchers with practical insight into when and how to apply these approaches to improve the rigor, realism, and ethical relevance of economic evaluations.