DID WE FOLLOW THE RIGHT APPROACH IN ECONOMIC EVALUATIONS BY DISCOUNTING HEALTH GAIN?

Abstract

OBJECTIVES: Discounting health is routinely applied in health economic evaluations causing debates 4 about its appropriate level and whether it should be equivalent or lower than discounting cost. Different 5 fundamental arguments were put forward to keep the discount rate for health the same as for cost. 6 Differential discounting may cause inconsistencies in the interpretation of the results or may cause 7 paradoxes in initiating prevention. The question we have however is different, is health gain a suitable 8 measure to be discounted like money is? 9 METHODS: Looking at economic assessments of consumable goods, discounting is only applied to the 10 monetary value. Money is a flexible instrument for trading purposes, but subject to value changes over time. 11 With money, product value can be expressed with value-based pricing processes the consumer is willing to 12 pay. Money is then discounted in that process because its amount allows to do other things within different 13 time periods. However, the outcomes of the processes that can be instantaneous or continuous such as 14 energy (joules), distance travelled (km), cooling periods (temperature), are not part of the discounting if the 15 outcome is produced over a long duration period. 16 RESULTS: In health economics of new interventions brought into the market, values are presented with an 17 obliged discount for the heath outcome that could however be considered equivalent to energy, travelled 18 distance, cooling periods, and the like. We are presenting a list of comparative conditions between the 19 economic assessment of consumable goods versus the situation in healthcare in which paradoxical 20 conditions are highlighted especially related to the situation of vaccine prevention. 21 CONCLUSIONS: This analysis should give us the right arguments that health gain is not a suitable 22 outcome measure for being discounted. 23 24