To be or not to be: Future lives in economic evaluation

Area of Science:

• Health Economics
• Bioethics
• Public Health Policy

Background:

• Healthcare interventions can influence the health and existence of future populations.
• Current health-economic evaluation (HEE) guidelines implicitly include future outcomes but lack consistent application and present counterintuitive implications.
• The valuation of future lives in HEE remains a complex ethical and methodological challenge.

Purpose of the Study:

• To propose a refined framework for incorporating future health outcomes into Health Technology Assessment (HTA).
• To differentiate between future lives that are certain to exist and those whose existence is contingent on specific healthcare choices.
• To provide a more intuitive and consistently applicable approach to HEE.

Main Methods:

• Conceptual analysis and ethical reasoning applied to HEE principles.
• Development of a distinction between 'necessary' future lives and 'potential' future lives.
• Application of the proposed distinction to analyze its impact on HEE and cost-effectiveness.

Main Results:

• A proposed distinction categorizes future lives into 'necessary' (independent of healthcare choices) and 'potential' (dependent on healthcare choices).
• Necessary future lives should be included in HEE, while potential future lives should be excluded.
• This distinction offers a more intuitive approach to HTA and resolves inconsistencies in current practice.

Conclusions:

• The proposed framework provides a clearer ethical and practical basis for valuing future lives in HEE.
• Distinguishing between necessary and potential future lives enhances the transparency and validity of HTA.
• Implementing this distinction can alter the cost-effectiveness of interventions affecting future populations.