[Unequal discounting of health care costs and effects causes confusion]

Discounting is a widely accepted practice in cost-effectiveness analysis to weigh future costs and effects for their timing. In 2006, the Dutch Health Care Insurance Board revised its recommended rates for discounting. They recommended differential discounting of costs and effects, whereby effects are discounted at a lower rate relative to the costs. The question is whether this guideline is to be generally used for decision-making in the Netherlands. We show how the use of unequal discount rates leads to confusing cost-effectiveness results and why further implementation guidelines are essential.