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A dollar is a dollar is a dollar--or is it?
Werner B F Brouwer1, N Job A van Exel, Rob M P M Baltussen
1Department of Health Policy & Management and institute for Medical Technology Assessment, Erasmus University/Erasmus Medical Centre, Rotterdam, The Netherlands. Brouwer@bmg.eur.nl
Summary
Economic evaluations often use a societal perspective, but this may not align with healthcare decision-makers
Area of Science:
- Health Economics
- Decision Analysis
- Public Policy
Background:
- Standard economic evaluations advocate for a societal perspective, encompassing all costs and effects.
- This broad societal perspective can conflict with the practical needs of healthcare decision-makers.
- A discrepancy exists between the economically ideal societal viewpoint and the practical aim of aiding healthcare policy.
Purpose of the Study:
- To argue that not all costs hold equal importance for healthcare decision-making.
- To explore the conflict between the societal perspective and the goal of supporting healthcare decision-makers.
- To introduce the concept of local rationality in the context of healthcare economic evaluations.
Main Methods:
- Conceptual analysis of economic evaluation perspectives.
- Identification of factors influencing cost importance: relevance, equity, and responsibility.
- Proposal of a two-perspective approach (healthcare vs. societal) for cost-effectiveness analysis.
Main Results:
- Not all costs are equally relevant for healthcare decision-makers.
- Relevance, equity, and responsibility are key factors in prioritizing costs.
- A dual-perspective approach (healthcare and societal) is proposed as a standard.
Conclusions:
- A strict healthcare perspective can better assist policymakers in achieving specific health goals.
- The societal perspective validates whether narrow healthcare decisions align with broader societal optimality.
- Further research is needed on actual decisions to understand the weighting of different cost types.
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