Cost-effectiveness Analysis: What are the Equity Implications? Does It Support or Undermine Primary Health Care? Cost-effectiveness analysis (CEA) has become an increasingly important tool for analyzing health care systems and setting priorities. CEA was strongly endorsed by the World Bank in its 1993 report on Investing in Health as a way of ensuring that health systems provide “value for money,” and is now being promoted by other agencies as well, as in the case of the World Health Organization’s WHO-CHOICE initiative. But is CEA a reliable way of getting the most out of limited health system resources? Or does it, rather, distract attention from equity concerns, undermine initiatives to provide primary health care, and distract us from directly challenging political choices that limit resources available for health systems? We have organized a participation-oriented workshop on these questions at the International Society for Equity in Health (ISEqH) meetings in Durban, South Africa. The workshop will be held from 10:30 am - 12:30 pm on June 12. We begin from a deep scepticism about CEA, because it often appears to presume that the effects of health interventions are independent of social and economic determinants of health, and can be measured in a unidimensional way. We are open to changing our minds – or to becoming even more sceptical. We will provide a presentation that organizes the issues and identifies key questions for further research and advocacy. Workshop participants will then engage in an interactive exercise in which they discuss their their own experience (as researchers, clinicians, health care managers or advocates) with the application of health system priorities. The objective will be to develop a list of equity-related axioms to constrain and supplement CEA in prioritizing interventions to improve population health. We therefore invite people who can provide detailed case studies, or direct us toward such case studies, to (a) contact us with background information, and (b) participate in the workshop if they will be in Durban for the ISEqH meetings. Please feel free, as well, to pass this inquiry on to others who may be interested. With best wishes, David Sanders, lmartin@uwc.ac.za School of Public Health, University of the Western Cape, South Africa Ted Schrecker, schrecker@usask.ca Saskatchewan Public Health and Evaluation Research Unit, University of Saskatchewan, Canada