International Journal of Health Policy and Management

International Journal of Health Policy and Management

Don’t Discount Societal Value in Cost-Effectiveness; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”

Document Type : Commentary

Author
William Hall
Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
10.15171/ijhpm.2017.03
Abstract
As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including ‘evidence-informed deliberative processes.’ However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like ‘evidence-informed deliberative processes’ could be one way of achieving this laudable goal.
Keywords
Cost-Effectiveness
Priority Setting
Resource Allocation
Multi-Criterion Decision Analysis (MCDA)
Deliberative Processes
Subjects
  1. Baltussen R, Jansen M, Mikkelsen E, et al. Priority setting for universal health coverage: we need evidence-informed deliberative processes, not just more evidence on cost-effectiveness. Int J Health Policy Manag. 2016;5(11):615-618. doi:10.15171/ijhpm.2016.83
  2. Edlin R, McCabe C, Hulme C, Hall P, Wright J. Cost Effectiveness Modelling for Health Technology Assessment: A Practical Course. Springer; 2015:217.
  3. Brouwer WBF, Culyer AJ, van Exel NJA, Rutten FFH. Welfarism vs. extra-welfarism. J Health Econ. 2008;27(2):325-338.
  4. Welfarists vs. Extra-welfarists. Healthcare Economist blog. http://healthcare-economist.com/2008/02/13/welfarists-vs-extra-welfarists/. Accessed November 7, 2016.
  5. Gold MR. Cost-Effectiveness in Health and Medicine. USA: Oxford University Press; 1996:462.
  6. Sen A. Equality of what? - The Tanner Lecture on Human Values. http://hdrnet.org/43/1/sen80.pdf. Published 1979.
  7. Musgrave RA. The Theory of Public Finance: A Study in Public Economy. McGraw-Hill; 1959:658.
  8. Tobin J. On Limiting the Domain of Inequality. J Law Econ. 1970;13(2):263-277.
  9. Rawls J. A Theory of Justice: Original Edition. Cambridge, Mass: Belknap Press; 2005:624.
  10. Brazier J. Measuring and Valuing Health Benefits for Economic Evaluation. Oxford University Press; 2007. http://www.oupcanada.com/catalog/9780198569824.html. Accessed November 8, 2016.
  11. ICECAP capability measures - University of Birmingham. http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/HE/ICECAP/index.aspx. Accessed November 8, 2016.
  12. ASCOT. PSSRU  website. http://www.pssru.ac.uk/ascot/. Accessed November 8, 2016.
  13. Mooney G. Beyond health outcomes: the benefits of health care. Health Care Anal. 1998;6(2):99–105.
  14. McNamee P, Seymour J. Incorporation of process preferences within the QALY framework: a study of alternative methods. Med Decis Making. 2008;28(3):443-452. doi:10.1177/0272989X07312473
  15. Williams A. Intergenerational equity: an exploration of the “fair innings” argument. Health Econ. 1997;6(2):117-132.
  16. Brock DW, Wikler D. Ethical Issues in Resource Allocation, Research, and New Product Development. In: Jamison DT, Breman JG, Measham AR, et al, eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington (DC): World Bank; 2006.
  17. Mullen PM. Quantifying priorities in healthcare: transparency or illusion? Health Serv Manage Res. 2004;17(1):47-58.
  18. Nord E. The person-trade-off approach to valuing health care programs. Med Decis Making. 1995;15(3):201-218.
  19. Stolk EA, van Donselaar G, Brouwer WBF, Busschbach JJV. Reconciliation of economic concerns and health policy: illustration of an equity adjustment procedure using proportional shortfall. Pharmacoeconomics. 2004;22(17):1097-1107.
  20. Drummond MF, McGuire A. Economic Evaluation in Health Care: Merging Theory with Practice. Oxford: Oxford University Press; 2001:304.
  21. McCabe C. MCDA and Health Technology Assessment. http://chspr.sites.olt.ubc.ca/files/2015/06/MCCABE-Chris.pdf. Accessed November 8, 2016.
  22. Sen A. Capability and Well-Being. Oxford: Clarendon Press; 1993. http://digamo.free.fr/hausman8.pdf#page=276.
  23. Daniels N, Sabin JE. Accountability for reasonableness: an update. BMJ. 2008;337:a1850. doi:10.1136/bmj.a1850
  24. Stufflebeam DL, editor. Evaluation Models: New Directions for Evaluation, Number 89. 1st ed. Jossey-Bass; 2001:106.
  25. Shadish WR, Cook TD, Leviton LC. Foundations of Program Evaluation: Theories of Practice. Newbury Park, CA: Sage Publications; 1990:536.
  26. Smith N, Mitton C, Cornelissen E, Gibson J, Peacock S. Using evaluation theory in priority setting and resource allocation. J Health Organ Manag. 2012;26(5):655-671.
  27. Smith N, Hall W, Mitton C, Bryan S, Urquhart B. What constitutes high performance in priority setting and resource allocation? Decision maker narratives identified from a survey and qualitative study in Canadian healthcare organizations. Health Serv Manage Res. 2014. pii: 0951484814559714.
  28. Peacock S, Mitton C, Bate A, McCoy B, Donaldson C. Overcoming barriers to priority setting using interdisciplinary methods. Health Policy. 2009;92(2–3):124-132.
International Journal of Health Policy and Management
Volume 6, Issue 9
2017
Pages 543-545

  • Received Date 14 November 2016
  • Revised Date 14 January 2017
  • Accepted Date 08 January 2017
  • First Published Date 01 September 2017
  • Published Date 01 September 2017