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- Main article: Health care costs
Cost-benefit analysis is a term that refers both to:
- helping to appraise, or assess, the case for a project or proposal, which itself is a process known as project appraisal; and
- an informal approach to making decisions of any kind.
Under both definitions the process involves, whether explicitly or implicitly, weighing the total expected costs against the total expected benefits of one or more actions in order to choose the best or most profitable option. The formal process is often referred to as either CBA (Cost-Benefit Analysis) or BCA (Benefit-Cost Analysis).
Benefits and costs are often expressed in money terms, and are adjusted for the time value of money, so that all flows of benefits and flows of project costs over time (which tend to occur at different points in time) are expressed on a common basis in terms of their “present value.” Closely related, but slightly different, formal techniques include cost-effectiveness analysis, economic impact analysis, fiscal impact analysis and Social Return on Investment (SROI) analysis. The latter builds upon the logic of cost-benefit analysis, but differs in that it is explicitly designed to inform the practical decision-making of enterprise managers and investors focused on optimising their social and environmental impacts.
Cost–benefit analysis is typically used by governments to evaluate the desirability of a given intervention. It is heavily used in today's government. It is an analysis of the cost effectiveness of different alternatives in order to see whether the benefits outweigh the costs. The aim is to gauge the efficiency of the intervention relative to the status quo. The costs and benefits of the impacts of an intervention are evaluated in terms of the public's willingness to pay for them (benefits) or willingness to pay to avoid them (costs). Inputs are typically measured in terms of opportunity costs - the value in their best alternative use. The guiding principle is to list all parties affected by an intervention and place a monetary value of the effect it has on their welfare as it would be valued by them.
The process involves monetary value of initial and ongoing expenses vs. expected return. Constructing plausible measures of the costs and benefits of specific actions is often very difficult. In practice, analysts try to estimate costs and benefits either by using survey methods or by drawing inferences from market behavior. For example, a product manager may compare manufacturing and marketing expenses with projected sales for a proposed product and decide to produce it only if he expects the revenues to eventually recoup the costs. Cost–benefit analysis attempts to put all relevant costs and benefits on a common temporal footing. A discount rate is chosen, which is then used to compute all relevant future costs and benefits in present-value terms. Most commonly, the discount rate used for present-value calculations is an interest rate taken from financial markets (R.H. Frank 2000). This can be very controversial; for example, a high discount rate implies a very low value on the welfare of future generations, which may have a huge impact on the desirability of interventions to help the environment. Empirical studies suggest that in reality, people's discount rates do decline over time. Because cost–benefit analysis aims to measure the public's true willingness to pay, this feature is typically built into studies.
During cost–benefit analysis, monetary values may also be assigned to less tangible effects such as the various risks that could contribute to partial or total project failure, such as loss of reputation, market penetration, or long-term enterprise strategy alignments. This is especially true when governments use the technique, for instance to decide whether to introduce business regulation, build a new road, or offer a new drug through the state healthcare system. In this case, a value must be put on human life or the environment, often causing great controversy. For example, the cost–benefit principle says that we should install a guardrail on a dangerous stretch of mountain road if the dollar cost of doing so is less than the implicit dollar value of the injuries, deaths, and property damage thus prevented (R.H. Frank 2000).
Cost–benefit calculations typically involve using time value of money formulas. This is usually done by converting the future expected streams of costs and benefits with a present value amount.
Opportunity cost Inputs
Net benefits Policy
Willingness to pay Outputs
Application and history
Cost–benefit analysis is used mainly to assess the monetary value of very large private and public sector projects. This is because such projects tend to include costs and benefits that are less amenable to being expressed in financial or monetary terms (e.g., environmental damage), as well as those that can be expressed in monetary terms. Private sector organizations tend to make much more use of other project appraisal techniques, such as rate of return, where feasible.
The practice of cost–benefit analysis differs between countries and between sectors (e.g., transport, health) within countries. Some of the main differences include the types of impacts that are included as costs and benefits within appraisals, the extent to which impacts are expressed in monetary terms, and differences in the discount rate between countries. Agencies across the world rely on a basic set of key cost–benefit indicators, including the following:
- NPV (net present value)
- PVB (present value of benefits)
- PVC (present value of costs)
- BCR (benefit cost ratio = PVB / PVC)
- Net benefit (= PVB - PVC)
- NPV/k (where k is the level of funds available)
The concept of CBA dates back to an 1848 article by Dupuit and was formalized in subsequent works by Alfred Marshall. The practical application of CBA was initiated in the US by the Corps of Engineers, after the Federal Navigation Act of 1936 effectively required cost–benefit analysis for proposed federal waterway infrastructure.  The Flood Control Act of 1939 was instrumental in establishing CBA as federal policy. It specified the standard that "the benefits to whomever they accrue [be] in excess of the estimated costs.
Subsequently, cost–benefit techniques were applied to the development of highway and motorway investments in the US and UK in the 1950s and 1960s. An early and often-quoted, more developed application of the technique was made to London Underground's Victoria Line. Over the last 40 years, cost–benefit techniques have gradually developed to the extent that substantial guidance now exists on how transport projects should be appraised in many countries around the world.
In the UK, the New Approach to Appraisal (NATA) was introduced by the then Department for Transport, Environment and the Regions. This brought together cost–benefit results with those from detailed environmental impact assessments and presented them in a balanced way. NATA was first applied to national road schemes in the 1998 Roads Review but subsequently rolled out to all modes of transport. It is now a cornerstone of transport appraisal in the UK and is maintained and developed by the Department for Transport.
The EU's 'Developing Harmonised European Approaches for Transport Costing and Project Assessment' (HEATCO) project, part of its Sixth Framework Programme, has reviewed transport appraisal guidance across EU member states and found that significant differences exist between countries. HEATCO's aim is to develop guidelines to harmonise transport appraisal practice across the EU. 
Transport Canada has also promoted the use of CBA for major transport investments since the issuance of its Guidebook in 1994.
More recent guidance has been provided by the United States Department of Transportation and several state transportation departments, with discussion of available software tools for application of CBA in transportation, including HERS, BCA.Net, StatBenCost, CalBC, and TREDIS. Available guides are provided by the Federal Highway Administration, Federal Aviation Administration, Minnesota Department of Transportation, and California Department of Transportation (Caltrans).
In the early 1960s, CBA was also extended to assessment of the relative benefits and costs of healthcare and education in works by Burton Weisbrod. Later, the United States Department of Health and Human Services issued its CBA Guidebook.
The accuracy of the outcome of a cost–benefit analysis depends on how accurately costs and benefits have been estimated. A peer-reviewed study  of the accuracy of cost estimates in transportation infrastructure planning found that for rail projects actual costs turned out to be on average 44.7 percent higher than estimated costs, and for roads 20.4 percent higher (Flyvbjerg, Holm, and Buhl, 2002). For benefits, another peer-reviewed study  found that actual rail ridership was on average 51.4 percent lower than estimated ridership; for roads it was found that for half of all projects estimated traffic was wrong by more than 20 percent (Flyvbjerg, Holm, and Buhl, 2005). Comparative studies indicate that similar inaccuracies apply to fields other than transportation. These studies indicate that the outcomes of cost–benefit analyses should be treated with caution because they may be highly inaccurate. In fact, inaccurate cost–benefit analyses may be argued to be a substantial risk in planning, because inaccuracies of the size documented are likely to lead to inefficient decisions, as defined by Pareto and Kaldor-Hicks efficiency ( Flyvbjerg, Bruzelius, and Rothengatter, 2003).
These outcomes (almost always tending to underestimation unless significant new approaches are overlooked) are to be expected because such estimates:
- Rely heavily on past like projects (often differing markedly in function or size and certainly in the skill levels of the team members)
- Rely heavily on the project's members to identify (remember from their collective past experiences) the significant cost drivers
- Rely on very crude heuristics to estimate the money cost of the intangible elements
- Are unable to completely dispel the usually unconscious biases of the team members (who often have a vested interest in a decision to go ahead) and the natural psychological tendency to "think positive" (whatever that involves)
Another challenge to cost–benefit analysis comes from determining which costs should be included in an analysis (the significant cost drivers). This is often controversial because organizations or interest groups may think that some costs should be included or excluded from a study.
In the case of the Ford Pinto (where, because of design flaws, the Pinto was liable to burst into flames in a rear-impact collision), the Ford company's decision was not to issue a recall. Ford's cost–benefit analysis had estimated that based on the number of cars in use and the probable accident rate, deaths due to the design flaw would run about $49.5 million (the amount Ford would pay out of court to settle wrongful death lawsuits). This was estimated to be less than the cost of issuing a recall ($137.5 million) . In the event, Ford overlooked (or considered insignificant) the costs of the negative publicity so engendered, which turned out to be quite significant (because it led to the recall anyway and to measurable losses in sales).
In the field of health economics, some analysts think cost–benefit analysis can be an inadequate measure because willingness-to-pay methods of determining the value of human life can be subject to bias according to income inequity. They support use of variants such as cost-utility analysis and quality-adjusted life year to analyze the effects of health policies.
- Applied Information Economics
- Benefit shortfall
- Business case
- Cost overrun
- Financial analysis
- Kaldor-Hicks efficiency - economic principle underlying cost–benefit analysis
- Net present value - a similar type of calculation
- Optimism bias
- Parametric estimating - cost estimating method
- Pareto efficiency - alternative economic principle
- Reference class forecasting
- Risk-benefit analysis - in many decisions, such as in biomedical research, the cost is replaced by risk.
- History of Benefit-Cost Analysis, Proceedings of the 2006 Cost Benefit Conference 
- Google book extract from Cases in Public Policy Analysis By George M. Guess, Paul G. Farnham
- Guide to Cost-Benefit Analysis of Investment Projects. Evaluation Unit, DG Regional Policy, European Commission, 2002. 
- Guide to Benefit-Cost Analysis in Transport Canada. Transport Canada. Economic Evaluation Branch, Transport Canada, Ottawa, 1994
- US Federal Highway Administration: Economic Analysis Primer: Benefit-Cost Analysis 2003 
- US Federal Highway Administration: Cost-Benefit Forecasting Toolbox for Highways, Circa 2001 
- US Federal Aviation Administration: Airport Benefit-Cost Analysis Guidance, 1999
- Minnesota Department of Transportation: Benefit Cost Analysis. MN DOT Office of Investment Management
- California Department of Transportation: Benefit-Cost Analysis Guide for Transportation Planning
- Weisbrod, Burton: “Does Better Health Pay?” Public Health Report, vol. 75, June 1960, pp. 557-60.
- Weisbrod, Burton: “Education and Investment in Human Capital,” Journal of Political Economy, Supplement, vol. 70, no. 5, part 2, October 1962, pp. 106-23 (reprinted in B. Kiker, ed., Investment in Human Capital, University of South Carolina, Columbia, SC, 1971; also R. Wykstra, ed., Human Capital Formation and Manpower Development, The Free Press, New York, 1971)
- US Department of Health And Human Services: Feasibility, Alternatives, And Cost/Benefit Analysis Guide, July 1993 
- Ascott, Elizabeth. 2006. Benefit Cost Analysis of Wonderworld Drive Overpass in San Marcos, Texas. Applied Research Project. , Texas State University
- Bent Flyvbjerg, Mette K. Skamris Holm, and Søren L. Buhl, "Underestimating Costs in Public Works Projects: Error or Lie?" Journal of the American Planning Association, vol. 68, no. 3, Summer 2002, pp. 279-295. 
- Bent Flyvbjerg, Mette K. Skamris Holm, and Søren L. Buhl, "How (In)accurate Are Demand Forecasts in Public Works Projects? The Case of Transportation." Journal of the American Planning Association, vol. 71, no. 2, Spring 2005, pp. 131-146. 
- Bent Flyvbjerg, Nils Bruzelius, and Werner Rothengatter, Megaprojects and Risk: An Anatomy of Ambition (Cambridge University Press, 2003). 
- Benefit/Cost Analysis: Introduction. Mankato State University. undated. 
- Chakravarty, Sukhamoy (1987). "cost-benefit analysis," The New Palgrave: A Dictionary of Economics, v. 1, pp. 687-90.
- Folland, Sherman, Allen C. Goodman and Miron Stano. The Economics of Heath and Health Care. Fifth ed. Pearson Prentice Hall: New Jersey, 2007. pg 83, 84.
- Portney, Paul R., Benefit-Cost Analysis, in The Library Of Economics and Liberty. 
- Tevfik F. Nas, Cost-Benefit Analysis: Theory and Application (Thousand Oaks, Ca.: Sage, 1996). 
-  - Cost-Benefit Analysis Course at the Harris School of Public Policy Studies
-  - The Environmental Valuation & Cost-Benefit Website
-  - Environmental Valuation & Cost-Benefit News
-  - Caltrans Guide to Benefit-Cost Analysis
-  - Inaccuracy in cost estimates
-  - Inaccuracy in benefit estimates
- Decision Analysis in Health Care George Mason University online course offering lectures and tools for measuring cost-effectiveness in health care scenarios.
- Cost-Benefit Analysis on Clinfowiki
- Reports on cost-benefit analysis and the environment in Tropical countries
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