Valuing prevention through economic evaluations
In cost-effectiveness analysis, the valuing of costs and health effects over timeremains a controversial issue. The debate mostly focuses on whether the discountrates for health and money should be equal and which discounting model and timepreferences are most appropriate. In this paper we add to the debate by arguingthat the assessment of effectiveness of a preventive intervention may influence thechoice of the discounting procedure for health.Health effects in cost-effectiveness analysis are commonly expressed inlife-years gained, QALYs gained or lives saved. These denominators are onlyindirect and partial measures of the effects of a preventive intervention. The actualeffect of the intervention is a reduction of the risk of mortality and morbidity in agiven period of time. This risk reduction will not always coincide with themoment at which the impact on (quality-adjusted) life-years gained is made (i.e. atrisk exposure), for example when preventing chronic disease with an asymptomaticstage. In this paper we show that truly acknowledging the origin of healthbenefits could have implications for the discounting procedure. We present adiscounting model that adequately focuses on the reduction of risk. This modelrecognises the potential interpretation of risk reduction for infection as an economicgood to be acquired with associated mortality reductions as later indirecteffects. This implies that our suggested discounting model focuses on themornentrs) of risk reduction. A numerical example illustrates our approach. Wediscuss the associated potential implications for public health policy and discusshow the effects of the intervention can be additionally corrected for societalpreferences.
Year of publication: |
2001
|
---|---|
Authors: | Beutels, P. ; Bos, J. ; Postma, M. ; Annemans, L. |
Publisher: |
American Society for Testing and Materials |
Saved in:
freely available
Saved in favorites
Similar items by person
-
Do costs of varicella justify routine infant vaccination?
Postma, M., (2004)
-
Bos, J., (2006)
-
Beutels, P., (2008)
- More ...