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Ethical Objections Against Including Life-Extension Costs in Cost-Effectiveness Analysis: A Consistent Approach

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  • Afschin Gandjour
  • Dirk Müller

Abstract

One of the major ethical concerns regarding cost-effectiveness analysis in health care has been the inclusion of life-extension costs (“it is cheaper to let people die”). For this reason, many analysts have opted to rule out life-extension costs from the analysis. However, surprisingly little has been written in the health economics literature regarding this ethical concern and the resulting practice. The purpose of this work was to present a framework and potential solution for ethical objections against life-extension costs. This work found three levels of ethical concern: (i) with respect to all life-extension costs (disease-related and -unrelated); (ii) with respect to disease-unrelated costs only; and (iii) regarding disease-unrelated costs plus disease-related costs not influenced by the intervention. Excluding all life-extension costs for ethical reasons would require—for reasons of consistency—a simultaneous exclusion of savings from reducing morbidity. At the other extreme, excluding only disease-unrelated life-extension costs for ethical reasons would require—again for reasons of consistency—the exclusion of health gains due to treatment of unrelated diseases. Therefore, addressing ethical concerns regarding the inclusion of life-extension costs necessitates fundamental changes in the calculation of cost effectiveness. Copyright Springer International Publishing Switzerland 2014

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  • Afschin Gandjour & Dirk Müller, 2014. "Ethical Objections Against Including Life-Extension Costs in Cost-Effectiveness Analysis: A Consistent Approach," Applied Health Economics and Health Policy, Springer, vol. 12(5), pages 471-476, October.
    • Handle: RePEc:spr:aphecp:v:12:y:2014:i:5:p:471-476
    DOI: 10.1007/s40258-014-0112-y
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    References listed on IDEAS

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    1. Afschin Gandjour, 2006. "Consumption costs and earnings during added years of life ‐ a reply to Nyman," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 315-317, March.
    2. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a ‘perfect’ cost–utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433, April.
    3. Bengt Liljas & Göran S. Karlsson & Nils‐Olov Stålhammar, 2008. "On future non‐medical costs in economic evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 17(5), pages 579-591, May.
    4. John A. Nyman, 2004. "Should the consumption of survivors be included as a cost in cost–utility analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 417-427, May.
    5. Jeffrey R. J. Richardson & Jan Abel Olsen, 2006. "In defence of societal sovereignty: a comment on Nyman ‘the inclusion of survivor consumption in CUA’," Health Economics, John Wiley & Sons, Ltd., vol. 15(3), pages 311-313, March.
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