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Different types of economic evaluation methods guide public policy decision making on how to allocate scarce public funds to competing investments. Cost-Benefit Analysis (CBA) is often used as a tool in, e.g., environmental and transport policy around the world. Cost-Effectiveness/Utility Analysis (CEA/CUA) is the dominant method for evaluating the health sector. In CBA, all costs and benefits are valued in monetary terms using the willingness to pay (WTP) approach to compare the present values of services and prices. The decision rule is simple in that if the net current value of the benefits outweighs the costs, the investment is said to increase social welfare. In CEA/CUA, outcomes are measured in some natural one-dimensional unit (CEA) or a multi-dimensional (in health) unit (CUA) (we will henceforth collectively refer to both as CEA). When applied to health care evaluations, the most common multi-dimensional outcome is quality-adjusted life years, which is the product of gained life years and the health-related quality of life in each life year (Svensson & Hultkrantz, 2017).
Economic evaluations of large public health interventions such as new vaccination programs attract particularly intense debates because of the high absolute costs (and potentially large benefits) involved. A primary focus of such debates has been whether current economic evaluation techniques capture the full scope and value of these public health programs. For instance, several reviews have found that vaccines may have broad, long-term societal consequences not always captured in CEAs. However, in principle, many of these benefits can be monetized and included in CEA based on a broader societal perspective as recommended by the US Second Panel on Cost-Effectiveness in Health and Medicine. Such comprehensive, non-health benefits of intervention include effects on future productivity and consumption, social services, educational achievement, and other societal impacts.
Several economists have instead proposed the use of cost-benefit analysis (CBA). The term CBA is often informally used to refer to any analysis used in decision-making that compares the expected costs and benefits of an investment. In principle, to be regarded as complete, a CBA should capture all services due to an intervention, valuing them either at their market value or at the level of consumption that individuals are willing to forego to obtain them. Hence, it has its conceptual roots in welfare economics, which quantifies social welfare in terms of individuals willingness-to-pay (WTP) to increase interest. By using a consistent, directly comparable metric to value all outcomes, CBA allows comparison with non-health interventions. A recent analysis estimated that the return on investment (a form of economic analysis that uses the same economic assumptions as CBA) for vaccines in low- and middle-income countries was comparable or superior to that for non-health interventions such as road safety (Park et al, 2018).
In the US, CBA is routinely used to evaluate health-promoting environmental and labor regulations. However, overtly using cost-effectiveness thresholds in healthcare spending decisions is considered taboo, in large part because narrowing patients healthcare choices is seen as a violation of their autonomy. As a result, the US spends substantially more on healthcare than the rest of the world, with minimal difference in outcomes. Despite the apparent rejection of CBA in healthcare, rationing decisions are made informally every day in the US. Hospitals and insurance companies have internal committees that decide what medications and treatments should be on a formulary or covered. Furthermore, many patients must make difficult rationing decisions when they cannot afford the out-of-pocket costs for medications and procedures (Soled et al, 2020).
Park, M., Jit, M. & Wu, J.T. (2018). Cost-benefit analysis of vaccination: a comparative study of eight approaches for valuing changes to mortality and morbidity risks. BMC Med. 16(139) https://doi.org/10.1186/s12916-018-1130-7
Soled, D., Bayefsky, M., & Nayak, R. (2020). When Does the Cure Become Worse Than the Disease? Applying Cost-Benefit Analysis to the Covid-19 Recovery. JME Blog. Retrieved from https://blogs.bmj.com/medical-ethics/2020/05/19/wh…
Svensson, M. & Hultkrantz, L. (2017). A Comparison of Cost-Benefit and Cost-Effectiveness Analysis in Practice: Divergent Policy Practices in Sweden. Nordic Journal of Health Economics, 5(2). pp. 41-53. doi: dx.doi.org/10.5617/njhe.1592
Respond to the bold paragraph ABOVE by using one of the option below… in APA format with At least two references and a minimum of 200 words….. .(The List of References should not be older than 2016 and should not be included in the word count.) Include at least one scholarly reference and appropriate in-text citations and Address all points on the DQ. One point will be deducted for not addressing each item mentioned above. Remember that presenting someone elses work as your own is plagiarism.
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REMEMBER IN APA FORMAT JOURNAL TITLES AND VOLUME NUMBERS ARE ITALICIZED.
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