Inequalities in Health, Inequalities in Health Care: Four Generations of Discussion about Justice and Cost-effectiveness Analysis Since at least the s, bioethics has addressed questions of justice in health policy. Much of the discussion has focused on health care, including the question of what role, if any, the techniques of cost-effectiveness analysis should play in the allocation of health care resources. In our view, this discussion has evolved through four generations of perspective and analysis, each asking different questions and seeking different solutions.
Health economics[ edit ] In health economics the purpose of CUA is to estimate the ratio between the cost of a health-related intervention and the benefit it produces in terms of the number of years lived in full health by the beneficiaries. Hence it can be considered a special case of cost-effectiveness analysisand the two terms are often used interchangeably.
Cost is measured in monetary units. Benefit needs to be expressed in a way that allows health states that are considered less preferable to full health to be given quantitative values.
However, unlike cost—benefit analysisthe benefits do not have to be expressed in monetary terms. If, for example, intervention A allows a patient to live for three additional years than if no intervention had taken place, but only with a quality of life weight of 0.
If intervention B confers two extra years of life at Cost utility analysis quality of life weight of 0. The net benefit of intervention A over intervention B is therefore 1.
The incremental cost-effectiveness ratio ICER is the ratio between the difference in costs and the difference in benefits of two interventions.
C1 and E1 would represent the cost and gain, respectively of taking a specific action.
These values are often used by policy makers and hospital administrators to determine relative priorities when determining treatments for disease conditions. It is important to note that CUA measures relative patient or general population utility of a treatment or pharmacoeconomic intervention.
Its results give no absolute indicator of the value of a certain treatment. According to a recent study "cost effectiveness often does not appear to be the dominant consideration in decisions about resource allocation made elsewhere in the NHS".
CUA provides a more complete analysis of total benefits than simple cost—benefit analysis does. However, in CUA, societal benefits and costs are often not taken into account.
Furthermore, some economists believe that measuring QALYs is more difficult than measuring the monetary value of life through health improvements, as is done with cost—benefit analysis.
This is because in CUA you need to measure the health improvement effects for every remaining year of life after the program is initiated. In addition, some people believe that life is priceless and there are ethical problems with placing a value on human life.
Also, the weighting of QALYs through time-trade-offstandard gamble, or visual analogue scale is highly subjective.
One involves QALY's lack of usefulness to the healthcare provider in determining the applicability of alternative treatments in the individual patient environment,  and the absence of incorporating the patient's willingness to pay i.
Specific health outcomes may also be difficult to quantify, thus making it difficult to compare all factors that may influence an individual's QALY.
Comparing an intervention's impact on the livelihood of a single woman to a mother of three; QALYs do not take into account the importance that an individual person may have for others' lives. Also, "The Secretary shall not utilize such an adjusted life year or such a similar measure as a threshold to determine coverage, reimbursement, or incentive programs under title XVIII".As a global leader in population health intelligence, we’re committed to providing the highest level of scientific evidence on the real-world value of medicines and health technologies.
INTRODUCTION. Depression is the most common psychiatric disorder in the general population  and the most common mental health condition in patients seen in primary care .Although symptoms of depression are prevalent among primary care patients, few patients discuss these symptoms directly with their primary care clinicians.
Cost–benefit analysis (CBA), sometimes called benefit costs analysis (BCA), is a systematic approach to estimating the strengths and weaknesses of alternatives (for example in transactions, activities, functional business requirements); it is used to determine options that provide the best approach to achieve benefits while preserving savings.
It may be used to compare potential (or. This analysis suggests that the introduction of a PrEP programme for MSM in the UK is cost-effective and possibly cost-saving in the long term.
A reduction in the cost of antiretroviral drugs (including the drugs used for PrEP) would substantially shorten the time for cost savings to be realised. Cost–utility analysis (CUA) is a form of financial analysis used to guide procurement decisions.
The most common and well-known application of this analysis is in pharmacoeconomics, especially health technology assessment (HTA). Health economics. In health economics the purpose of CUA is to estimate the ratio between the cost of a health.
The Medical Services Advisory Committee (MSAC) is an independent non-statutory committee established by the Australian Government Minister for Health in