Abstract
Every public health expenditure, including the one that saves lives or extends life expectancy of particular persons (target population), bears a cost. Although cost-effectiveness analysis (CEA) is routinely performed in health policy, ethical justification of CEA is rarely discussed. Also, there is neither consensus value nor even consensus method for determining cost-effectiveness threshold (CET) for life-extending measures. In this study, we performed ethical analysis of CEA by policy impact assessment based on connection of health and wealth (poorer people have statistically shorter life expectancies) and concluded that CEA is not only a practical but also an ethical necessity. To quantify CET, we used three independent methods: (1) literature survey of analyzing salaries in risky occupations, (2) utilizing Prospect Theory suggesting that people value their lives in monetary terms twice more than their lifetime earnings, and (3) literature survey of the U.S. current legal practice. To the best of our knowledge, nobody applied method (2) to determine CET. The three methods yielded rather similar results with CET about 1.0 ± 0.4 gross domestic product per capita (GDPpc) per quality-adjusted life-year. Therefore, a sum of not higher than 140% GDPpc is statistically sufficient to “purchase” an additional year of life—or, alternatively, to “rob” one year of life if taken away. Therefore, 140% GDP per capita per quality-adjusted life-year should be considered as the upper limit of prudent and ethically justified expenditure on life extension programs.
| Original language | English |
|---|---|
| Journal | Inquiry (United States) |
| Volume | 59 |
| DOIs | |
| State | Published - 2022 |
| Externally published | Yes |
Bibliographical note
Publisher Copyright:© The Author(s) 2022.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Jerusalem College of Technology grant №5969. The authors wish to thank Prof. Avi Caspi (Jerusalem College of Technology—JCT) for his encouragement of this work. We would like to thank Prof. Shlomo Engelberg (JCT) and Prof. Eli Sloutskin (Bar Ilan University) for thorough reading the manuscript and suggesting many important improvements. We also wish to thank Dr Moti Brill (Nuclear Research Center Negev, ret.), Prof. Noah Dana-Picard (JCT), the late Prof. Ludwik Dobrzyński (National Centre for Nuclear Research, Poland), Prof. Marek Janiak (Military Institute of Hygiene and Epidemiology, Poland), Dr Efraim Laor (Holon Institute of Technology), Prof. Michael Shapiro (Technion – Israel Institute of Technology), Dr Barak Tavron (Noga Ltd), and the late Prof. Alexander Vaiserman (Institute of Gerontology, Kiev, Ukraine) for fruitful discussions and constructive criticism. Last but not least, we would like to thank the anonymous reviewers whose constructive criticism enabled to considerably improve the manuscript. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Jerusalem College of Technology grant №5969.
| Funders | Funder number |
|---|---|
| Institute of Gerontology | 5969 |
| Military Institute of Hygiene and Epidemiology, Poland | |
| National Centre for Nuclear Research | |
| Athlone Institute of Technology | |
| Technion-Israel Institute of Technology |
Keywords
- cost-benefit analysis
- ethics
- health policy
- risk management
- willingness to pay
