If two interventions have identical outcomes, which analysis should be used?

• A. Cost-effectiveness analysis (CEA).
• B. Budget impact analysis (BIA).
• C. Cost-benefit analysis (CBA).
• D. Cost-minimization analysis (CMA).

Answer: (D)

When two interventions have the same effect, decision-making hinges on cost, not on additional health benefits. Cost-minimization analysis is designed for this exact situation: it assumes equivalent outcomes and compares only the costs from the chosen perspective to identify the least expensive option. In practice, CMA means you select the option with the lower total cost, since the effectiveness side is considered identical.

Understanding why the other analyses aren’t the right fit helps reinforce the idea. Cost-effectiveness analysis adds the dimension of cost per unit of health outcome, which isn’t needed when outcomes are the same. Cost-benefit analysis tries to monetize both costs and benefits, adding a value judgment about how much outcomes are worth, which isn’t required if effectiveness is equal. Budget impact analysis focuses on how adopting an option affects a payer’s budget in the short term, not on which option is cheaper given equal effectiveness.

Keep in mind that CMA should be used only when equivalence in outcomes is well established or clearly assumed; otherwise, differences in effectiveness would make CMA inappropriate.