## Abstract When health effects can be valued in monetary terms, as in costโbenefit analysis, they should be discounted at the same rate as costs. If health effects are measured in quantities (e.g. quality adjusted life years) as in costโeffectiveness analysis (CEA) and the value of health effects
Discounting costs and effects: a reconsideration
โ Scribed by Ben A. Van Hout
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 97 KB
- Volume
- 7
- Category
- Article
- ISSN
- 1057-9230
No coin nor oath required. For personal study only.
โฆ Synopsis
Using a simple societal utility function-giving equal weight to current and future generations -it is concluded that costs need to be discounted on the basis of the expected increase in income and the marginal utility of consumption, and that effects need to be discounted on the basis of the expected increase in health and the marginal utility of health. It is derived that both rates need to be equal when assuming a kind of perfect market, where growth rates are determined by the societal utility function. It is argued that this is an extremely heroic assumption and that different discount rates may be needed. Additionally, the traditional 'inconsistency arguments' of Weinstein and Stason and of Keeler and Cretin are reconsidered. Within the context presented earlier, the first inconsistency only emerges when a growth equilibrium is assumed, reinforcing the arguments put forward before. The Keeler and Cretin paradox is reconsidered by showing that absolutely no paradox emerges when programs are not supposed to stop after a year but are supposed to continue indefinitely. The conclusion is drawn that non-believers in market mechanisms assuring an optimal social policy, need to reconsider the use of their discount rates.
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## SUMMARY Nord (2011) criticizes standard arguments which assert that consistency requires that future health benefits must be discounted at the same rate as future costs in costโeffectiveness analysis (CEA). He suggests these arguments are misguided because they require transitivity of preference
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