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PharmacoEconomics
Published in: PharmacoEconomics 14/2002

01-12-2002 | Current Opinion

Theoretical Arguments for the Discounting of Health Consequences

Where Do We Go from Here?

Author: Angelina Lazaro

Published in: PharmacoEconomics | Issue 14/2002

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Abstract

Despite the theoretical arguments presented in the literature regarding discounting over the last 25 years, no satisfactory reply has yet been offered to the question of whether health consequences have to be discounted at the same rate as monetary consequences in the economic evaluation of health programmes or interventions designed to improve health. Against this background, the main objective of this paper was to review and systemise these theoretical arguments, with the aim of determining whether any of the positions identified can be accepted without reservation. Having determined that this is not possible, we investigated the rationality of discounting in the literature and, on this basis, propose a potential way to resolve the problem. Thus, we argue that the relationship between the discount of monetary and health consequences has to be determined in an indirect manner, by reference to the relationship maintained by the individual time preference rates for health and money in the context of private and social choice. Although this proposal moves the debate into the empirical field, its advantages must be weighed against the difficulties associated with the estimation of the time preferences.
Literature
1.
Johannesson M, Meltzer D. Some reflections on cost-effectiveness analysis. Health Econ 1998; 7 (1): 1–8PubMedCrossRef
2.
Anders A, Norinder A. Health outcome measures in cost-effectiveness studies: a review of original articles published between 1986 and 1996. Health Policy 1996 51 (2): 87–99
3.
Lipscomb J, Weinstein MC, Torrance GW. Time preference. In: Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost-effectiveness in health and medicine. New York: Oxford University Press, 1996: 214–46
4.
Smith D, Gravelle H. The practice of discounting economic evaluation of health care intervention. Int J Technol Assess Health Care 2001; 17 (2): 236–43PubMedCrossRef
5.
Viscusi WK. Discounting health effects for medical decisions. In: Sloan FA, editor. Valuing health care: costs, benefits and effectiveness of pharmaceuticals and other medical technologies. New York: Cambridge University Press, 1995: 123–45
6.
Johannesson M. Theory and methods of economic evaluation of health care. Dordrecht: Kluwer Academic Publishers, 1996
7.
Weinstein MC, Stason WB. Foundations of cost-effectiveness analysis for health and medical practices. N Engl J Med 1977; 296 (13): 716–21PubMedCrossRef
8.
Drummond MF, Jefferson TO. Guidelines for authors and peer reviewers of economic submissions to the BMJ. BMJ 1996; 313 (7052): 275–83PubMedCrossRef
9.
Russell LB. Is prevention better than cure? Washington DC: The Brookings Institution, 1986
10.
World Bank. World development report 1993: investing in health. New York: Oxford University Press, 1993
11.
Commonwealth Department of Human Services and Health. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee. Canberra: Australian Government Publishing Service, 1995
12.
Canadian Coordinating Office of Health Technology Assessment (CCOHTA). Guidelines for economic evaluation of pharmaceuticals: Canada, 2nd ed. Ottawa: CCOHTA, 1997
13.
14.
Hillman AL, Kim MS. Economic decision making in healthcare: a standard approach to discounting health outcomes. Pharmacoeconomics 1995; 7 (3): 198–205PubMedCrossRef
15.
Coyle D, Tolley K. Discounting of health benefits in the pharmacoeconomic analysis of drug therapies: an issue for debate? Pharmacoeconomics 1992; 2 (2): 153–62PubMedCrossRef
16.
Department of Health. Policy appraisal and health. London: Department of Health, 1996
17.
Krahn M, Gafni A. Discounting in the economic evaluation of health care interventions. Med Care 1993; 31 (5): 403–18PubMedCrossRef
18.
Keeler EB, Cretin S. Discounting of live-saving and other non-monetary effects. Manage Sci 1983; 29 (3): 300–6CrossRef
19.
Broome J. Discounting the future. Discussion Paper no.: 93/343.Bristol: University of Bristol; 1993
20.
Katz DA, Welch HG. Discounting in cost-effectiveness analysis of health care programmes. Pharmacoeconomics 1993; 3 (4): 276–85PubMedCrossRef
21.
Whittington D, MacRae Jr D. The issue of standing in cost-benefit analysis. J Policy Anal Manage 1986; 5 (4): 665–82CrossRef
22.
Drummond MF, Ludbrook A, Lowson K, et al. Studies in economic appraisal in health care: vol 2. Oxford: Oxford University Press, 1986
23.
Fuchs VR, Zeckhauser R. Valuing health: a “priceless” commodity. Am Econ Rev 1987; 77 (2): 263–8PubMed
24.
Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987
25.
26.
Grossman M. On the concept of health capital and the demand for health. J Polit Econ 1972; 80 (2): 223–55CrossRef
27.
Mooney GH. The valuation of human life. London: Macmillan, 1977
28.
West RR. Discounting the future: influence of economic model. J Epidemiol Community Health 1996; 50 (3): 239–44PubMedCrossRef
29.
Parfit D. Reasons and persons. Oxford: Clarendon Press, 1984
30.
Welch HG. Comparing apples and oranges: does cost-effectiveness analysis deal fairly with the old and the young? Gerontologist 1991; 31 (3): 332–6PubMedCrossRef
31.
Broome J. Choice and value in economics. Oxford Economic Papers 1981; 30: 313–33
32.
33.
Olsen JA. Time preference for health gains: an empirical investigation. Health Econ 1993; 2: 257–65PubMedCrossRef
34.
35.
Redelmeier DA, Heller DN, Weinstein MC. Time preference in medical economics: science or religion? Med Decis Making 1994; 14 (3): 301–3CrossRef
36.
37.
Weinstein MC. Estrogen use in postmenopausal women: cost, risks and benefits. N Engl J Med 1980; 303 (6): 308–16PubMedCrossRef
38.
Weinstein MC. Principles of cost-effective resource allocation in health care organizations. Int J Technol Assess Health Care 1990; 6 (1): 93–103PubMedCrossRef
39.
Gravelle H, Smith D. Discounting for health effects in cost benefit and cost effectiveness analysis. Health Econ 2001; 10 (7): 587–99PubMedCrossRef
40.
Cairns JA. Discounting and health benefits: another perspective. Health Econ 1992; 1: 75–9CrossRef
41.
Stokey E, Zeckhauser R. A primer for policy analysis. New York: WW Norton, 1978
42.
Benzion U, Gafni A. Evaluation of public investment in health care: is the risk irrelevant? J Health Econ 1983; 2: 161–5CrossRef
43.
Sheldon TA. Discounting in health care decision-making: time for a change? J Public Health Med 1992; 14 (3): 250–6PubMed
44.
Cairns JA. Health, wealth and time preference. Proj Appraisal 1992; 7 (1): 31–40CrossRef
45.
Mooney GH. Economics, medicine and health care. London: Harvester Wheatsheaf, 1986
46.
Gafni A, Torrance GW. Risk attitude and time preference in health. Manage Sci 1984; 30 (4): 440–51CrossRef
47.
48.
Fisher I. The theory of interest. New York: Macmillan, 1930
49.
Feldstein MS. The social time preference discount rate in cost benefit analysis. Econ J 1964; 74: 360–79CrossRef
50.
Bradford DF. Constraints of government investment opportunities and the choice of discount rate. Am Econ Rev 1975; 65 (5): 887–99
51.
Lind RC. Reassessing the government’s discount rate policy in light of new theory and date of a world economy with a degree of capital mobility. J Environ Econ Manage 1990; 18 (2): S8–S28CrossRef
52.
Robinson JC. Philosophical origins of the social rate of discount in cost-benefit analyses. Milbank Quarterly 1990; 68 (2): 245–65PubMedCrossRef
53.
54.
Marglin SA. The social rate of discount and the optimal rate of investment. Q J Econ 1963; 77: 96–111
55.
Gyrd-Hansen D, Søgaard J. Discounting life-years: wither time preference? Health Econ 1998; 7 (2): 121–7PubMedCrossRef
56.
Horowitz JK, Carson RT. Discounting statistical lives. J Risk Uncert 1990; 3: 403–13CrossRef
57.
Cairns JA. Discounting health benefits. Paper for the 2nd European Conference in Health Economics; 1992 Dec 16–18, Paris
58.
Chapman GB. Temporal discounting and utility for health and money. J Exp Psychol Learn Mem Cogn 1996; 22 (3): 771–91PubMedCrossRef
59.
Chapman GB, Coups EJ. Time preferences and preventive health behaviour: acceptance of the influenza vaccine. Med Decis Making 1999; 19 (3): 307–14PubMedCrossRef
60.
Ganiats TG, Carson RT, Hamm RM, et al. Population-based time preferences for future health outcomes. Med Decis Making 2000; 20: 263–70PubMedCrossRef
61.
Enemark U, Lyttkens CH, Troeng T, et al. Implicit discount rates of vascular surgeons in the management of abdominal aortic aneurysms. Med Decis Making 1998; 18 (2): 168–77PubMed
62.
63.
Cairns JA, Van der Pol MM. The estimation of marginal time preference in a UK-wide sample (TEMPUS) project. Health Technol Assess 2000; 4 (1): i–iv, 1–83PubMed
64.
Johannesson M, Johansson P-O. To be or not to be, that is the question: an empirical study of the WTP for an increased life expectancy at an advanced age. J Risk Uncertain 1996; 13: 163–74CrossRef
65.
Lazaro A, Barberan R, Rubio E. The discounted utility model and social preferences. An analysis of some aletrnative formulations to the conventional discounting. J Econ Psychology 2002; 23 (4): 313–37
66.
Chapman GB, Elstein AS. Valuing the future: temporal discounting in health and money. Med Decis Making 1995; 15 (4): 373–86PubMedCrossRef
67.
Lazaro A, Barberan R, Rubio E. Why discount health more than monetary consequences in the economic evaluation of health care programmes? Appl Econ 2002; 34 (3): 339–50CrossRef
68.
Lazaro A, Barberan R, Rubio E. Private and social time preferences for health and money: an empirical estimation. Health Econ 2001; 10 (4): 351–6PubMedCrossRef
Metadata
Title
Theoretical Arguments for the Discounting of Health Consequences
Where Do We Go from Here?
Author
Angelina Lazaro
Publication date
01-12-2002
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 14/2002
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200220140-00001