Discounting for health effects in cost-benefit and cost-effectiveness analysis
AbstractWhen health effects can be valued in monetary terms, as in cost-benefit analysis, they should be discounted at the same rate as costs. If health effects are measured in quantities (e.g. quality adjusted life years) as in cost-effectiveness analysis (CEA) and the value of health effects is increasing over time, discounting the volume of health effects at a lower rate than costs is a valid method of taking account of the increase in the future value of health effects. We show that the Keeler-Cretin paradox, often used as an argument against discounting health effects at a lower rate than costs, has no relevance for the choice of discount rate in CEA. We present individualistic and welfare models to argue that the rate of growth of the value of health effects is positive. The welfare model suggests that the value of health grows at a rate dependent on the rate of growth of the value of the direct effect of health on utility, the growth rate of income, the elasticity of the marginal utility of income and the extent to which individuals are insured against the income risks of ill health. Copyright © 2001 John Wiley & Sons, Ltd.
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Bibliographic InfoArticle provided by John Wiley & Sons, Ltd. in its journal Health Economics.
Volume (Year): 10 (2001)
Issue (Month): 7 ()
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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749
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- Hurley, Jeremiah, 2000. "An overview of the normative economics of the health sector," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 2, pages 55-118 Elsevier.
- A Diener & B O'Brien & A Gafni, 1997.
"Health Care Contingent Valuation Studies: A review and classification of the literature,"
Centre for Health Economics and Policy Analysis Working Paper Series
1997-07, Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada.
- Alan Diener & Bernie O'Brien & Amiram Gafni, 1998. "Health care contingent valuation studies: a review and classification of the literature," Health Economics, John Wiley & Sons, Ltd., vol. 7(4), pages 313-326.
- Blomqvist, A.G. & Carter, R.A.L., 1993.
"Is Health Care Really a Luxury?,"
UWO Department of Economics Working Papers
9311, University of Western Ontario, Department of Economics.
- Cropper, Maureen L. & G. Sussman, Frances, 1990. "Valuing future risks to life," Journal of Environmental Economics and Management, Elsevier, vol. 19(2), pages 160-174, September.
- Simon M. Burgess & Carol Propper, 1998. "Early health-related behaviours and their impact on later life chances: evidence from the US," Health Economics, John Wiley & Sons, Ltd., vol. 7(5), pages 381-399.
- Layard, Richard & Glaister, Stephen, 1994. "Cost-benefit analysis," Open Access publications from London School of Economics and Political Science http://eprints.lse.ac.uk/, London School of Economics and Political Science.
- Viscusi, W. Kip & Moore, Michael J., 1989. "Rates of time preference and valuations of the duration of life," Journal of Public Economics, Elsevier, vol. 38(3), pages 297-317, April.
- Klose, Thomas, 1999. "The contingent valuation method in health care," Health Policy, Elsevier, vol. 47(2), pages 97-123, May.
- Emmett B. Keeler & Shan Cretin, 1983. "Discounting of Life-Saving and Other Nonmonetary Effects," Management Science, INFORMS, vol. 29(3), pages 300-306, March.
- Cropper, Maureen L & Portney, Paul R, 1990. " Discounting and the Evaluation of Lifesaving Programs," Journal of Risk and Uncertainty, Springer, vol. 3(4), pages 369-79, December.
- Kenneth J. Arrow, . "Intergenerational Equity and the Rate of Discount in Long-Term Social Investment," Working Papers 97005, Stanford University, Department of Economics.
- Diane Dawson & Hugh Gravelle & Mary O'Mahony & Andrew Street & Martin Weale & Adriana Castelli & Rowena Jacobs & Paul Kind & Pete Loveridge & Stephen Martin & Philip Stevens & Lucy Stokes, 2005.
"Developing new approaches to measuring NHS outputs and productivity,"
006cherp, Centre for Health Economics, University of York, revised Dec 2005.
- Mary OMahony & Philip Stevens & Lucy Stokes & Pete Loveridge, 2005. "Developing new approaches to measuring NHS outputs and productivity," NIESR Discussion Papers 264, National Institute of Economic and Social Research.
- Cairns, John, 2006. "Developments in discounting: With special reference to future health events," Resource and Energy Economics, Elsevier, vol. 28(3), pages 282-297, August.
- Carl Lyttkens, 2003. "Time to disable DALYs?," The European Journal of Health Economics, Springer, vol. 4(3), pages 195-202, September.
- Ben Groom & Cameron Hepburn & Phoebe Koundouri & David Pearce, 2005. "Declining Discount Rates: The Long and the Short of it," Environmental & Resource Economics, European Association of Environmental and Resource Economists, vol. 32(4), pages 445-493, December.
- Olivier Chanel & Pascale Scapecchi & Jean-Christophe Vergnaud, 2006.
"How to correctly assess mortality benefits in public policies,"
UniversitÃ© Paris1 PanthÃ©on-Sorbonne (Post-Print and Working Papers)
- Olivier Chanel & Pascale Scapecchi & Jean-Christophe Vergnaud, 2006. "How to correctly assess mortality benefits in public policies," Journal of Environmental Planning and Management, Taylor and Francis Journals, vol. 49(5), pages 759-776.
- Mareike Schad & Jürgen John, 2012. "Towards a social discount rate for the economic evaluation of health technologies in Germany: an exploratory analysis," The European Journal of Health Economics, Springer, vol. 13(2), pages 127-144, April.
- Stephen Martin & Peter C Smith & Sheila Leatherman, 2006. "Value for money in the English NHS: Summary of the evidence," Working Papers 018cherp, Centre for Health Economics, University of York.
- Michael Spackman, 2011. "Government discounting controversies: changing prices, opportunity costs and systematic risk," Grantham Research Institute on Climate Change and the Environment Working Papers 67, Grantham Research Institute on Climate Change and the Environment.
- Phoebe Koundouri & Ben Groom, .
"Sustainability and the Economics of the Environment: Cost-Benefit Analysis and the Dynamics of the Long-Run Discount Rate,"
DEOS Working Papers
0903, Athens University of Economics and Business.
- Koundouri, Phoebe & Groom, Ben, 2009. "Sustainability and the Economics of the Environment: Cost-Benefit Analysis and the Dynamics of the Long-Run Discount Rate," MPRA Paper 38278, University Library of Munich, Germany.
- Mike Paulden & Karl Claxton, 2009. "Budget allocation and the revealed social rate of time preference for health," Working Papers 053cherp, Centre for Health Economics, University of York.
- James K. Hammitt, 2012.
"Discounting Health And Cost‐Effectiveness Analysis: A Response To Nord,"
John Wiley & Sons, Ltd., vol. 21(7), pages 878-882, 07.
- Hammitt, James K., 2012. "Discounting Health and Cost-Effectiveness Analysis : a response to Nord," Open Access publications from University of Toulouse 1 Capitole http://neeo.univ-tlse1.fr, University of Toulouse 1 Capitole.
- Hugh Gravelle & Werner Brouwer & Louis Niessen & Maarten Postma & Frans Rutten, 2007. "Discounting in economic evaluations: stepping forward towards optimal decision rules," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 307-317.
- Karl Claxton & Mark Sculpher & Anthony Culyer & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier, 2006. "Discounting and cost-effectiveness in NICE - stepping back to sort out a confusion," Health Economics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-4.
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