Which combination defines a dominated intervention?

• A. Lower cost and better outcomes.
• B. Lower cost and worse outcomes.
• C. Higher cost and better outcomes.
• D. Higher cost and worse outcomes.

Answer: (C)

In cost-effectiveness thinking, a dominated intervention is one that costs more and provides worse outcomes than another available option. That combination—higher cost and worse outcomes—is the hallmark of domination: you’d never choose it when there’s another option that costs less and yields better results.

So the scenario that fits a dominated choice is the one where you pay more and get a worse health or quality-of-life outcome. The alternative would be a cheaper option that delivers at least as good or better outcomes, making the costly, worse option unattractive.

To place the others in context: lower cost and better outcomes is the ideal, a clearly dominant option. Lower cost and worse outcomes is cheaper but less effective, which could still be acceptable only if there’s no better option and budget limits dictate; it isn’t dominated by itself. Higher cost and better outcomes represents a trade-off scenario: more expensive but more effective, which may be acceptable depending on the value placed on the extra benefit.