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Cost-Effectiveness in Health and Medicine$
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Peter J. Neumann, Theodore G. Ganiats, Louise B. Russell, Gillian D. Sanders, and Joanna E. Siegel

Print publication date: 2016

Print ISBN-13: 9780190492939

Published to Oxford Scholarship Online: November 2016

DOI: 10.1093/acprof:oso/9780190492939.001.0001

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Ethical and Distributive Considerations

Ethical and Distributive Considerations

(p.319) 12 Ethical and Distributive Considerations
Cost-Effectiveness in Health and Medicine

Dan W. Brock

Norman Daniels

Peter J. Neumann

Joanna E. Siegel

Oxford University Press

This new chapter begins by elaborating the ethical justification for considering the opportunity cost of an intervention that underlies the practice of cost-effectiveness analysis (CEA). Without such consideration, we would not know if there were better uses of the resources at hand. The chapter also reaffirms the original Panel’s principle that CEA is not by itself sufficient for decisions as it does not capture all relevant concerns. Most of the ethical issues in the use CEA are distributional issues that involve trade-offs between effects and costs for some patients versus others: How should states of health and disability be evaluated? Should all quality-adjusted life years (QALYs) count equally? Should priority be given to the patients who are the worst off? Does CEA unjustly discriminate against disabled persons? The chapter recommends the use of sensitivity analyses in many cases to illustrate the impact of alternative distributional choices.

Keywords:   Distributional issues, ethics, sensitivity analyses, disability, trade-offs

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