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Does cost-effectiveness analysis discriminate against patients with short life expectancy? Matters of logic and matters of context

Listed author(s):
  • Mike Paulden

    (Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Canada)

  • Anthony J Culyer

    (Department of Health Policy, Management and Evaluation, University of Toronto, Canada. Department of Economics and Related Studies, University of York, UK and Centre for Health Economics, University of York, UK)

The aim of this paper is to explore the claim of ageism made against the National Institute for Health & Clinical Excellence and like organisations, and to identify circumstances under which ageist discrimination might arise. We adopt a broad definition of ageism as representing any discrimination against individuals or groups of individuals solely on the basis that they have shorter life expectancy than others. A simple model of NICE?s decision making process is developed which demonstrates that NICE?s recommendations do not inherently discriminate on the basis of life expectancy per se but that scope for discrimination may arise in the case of specific technologies having identifiable characteristics. Such discrimination may favour patients with either longer or shorter life expectancy. It is shown that NICE?s policies, procedures and the context in which NICE makes its decisions not only reduce the scope for discriminatory recommendations but also – in the case of “end of life” treatments – increase the likelihood that NICE?s recommendations favour those with shorter, rather than longer, life expectancy.

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File Function: First version, 2010
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Paper provided by Centre for Health Economics, University of York in its series Working Papers with number 055cherp.

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Length: 15 pages
Date of creation: Feb 2010
Handle: RePEc:chy:respap:55cherp
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  1. 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.
  2. 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.
  3. Karl Claxton & Mike Paulden & Hugh Gravelle & Werner Brouwer & Anthony J. Culyer, 2011. "Discounting and decision making in the economic evaluation of health‐care technologies," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 2-15, January.
  4. 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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