Hidden costs

The ethics of cost-effectiveness analyses for health interventions in resource-limited settings

Dados Bibliográficos

ID15540472
AutoresSarah E Rutstein (0000-0002-1571-6576, University of North Carolina at Chapel Hill, autor correspondente), Joan T Price (0000-0003-4178-0405, University of North Carolina at Chapel Hill), Nora E Rosenberg (0000-0002-9759-9966, University of North Carolina at Chapel Hill), Rennie (0000-0003-3844-972X, University of North Carolina at Chapel Hill), Andrea K Biddle (0000-0003-0273-7439, University of North Carolina at Chapel Hill), William C Miller (0000-0003-3060-0210, University of North Carolina at Chapel Hill)
Ano2016
Volume12
Fascículo10
Páginas1269-1281
Data de publicação2016-05-04
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoGlobal Public Health (JOURNAL)
Identificadores do periódicoISSN: 1744-1692 • E-ISSN: 1744-1706
EditoraTaylor & Francis (PUBLISHER • GB)
DOI10.1080/17441692.2016.1178319
PMID27141969
OpenAlexW2345985679
IdiomaEN
Citações recebidas5
Referências citadas52

Cost-effectiveness analysis (CEA) is an increasingly appealing tool for evaluating and comparing health-related interventions in resource-limited settings. The goal is to inform decision-makers regarding the health benefits and associated costs of alternative interventions, helping guide allocation of limited resources by prioritising interventions that offer the most health for the least money. Although only one component of a more complex decision-making process, CEAs influence the distribution of health-care resources, directly influencing morbidity and mortality for the world's most vulnerable populations. However, CEA-associated measures are frequently setting-specific valuations, and CEA outcomes may violate ethical principles of equity and distributive justice. We examine the assumptions and analytical tools used in CEAs that may conflict with societal values. We then evaluate contextual features unique to resource-limited settings, including the source of health-state utilities and disability weights, implications of CEA thresholds in light of economic uncertainty, and the role of external donors. Finally, we explore opportunities to help align interpretation of CEA outcomes with values and budgetary constraints in resource-limited settings. The ethical implications of CEAs in resource-limited settings are vast. It is imperative that CEA outcome summary measures and implementation thresholds adequately reflect societal values and ethical priorities in resource-limited settings

Actuarial science · Business · Cost effectiveness · Cost-effectiveness analysis · Cost–benefit analysis · Distributive justice · Economic growth · Economic Justice · Economics · Equity (law · Health care · Health care rationing · Health equity · Management science · Political science · Psychological intervention · Public economics · Resource (disambiguation · Resource allocation · Risk analysis (engineering · Computer Science · Global Maternal and Child Health · Health Systems, Economic Evaluations, Quality of Life · Healthcare cost, quality, practices · Medicine · Nursing · Psychology