Dolan Paul, Edlin Richard
Department of Economics, Sheffield Health Economics Group, University of Sheffield, UK.
J Health Econ. 2002 Sep;21(5):827-43. doi: 10.1016/s0167-6296(02)00011-5.
Cost-benefit analysis (CBA) is a recognised as the economic evaluation technique that accords most with the underlying principles of standard welfare economic theory. However, due to problems associated with the technique, economists evaluating resources allocation decisions in health care have most often used cost-effective analysis (CEA), in which health benefits are expressed in non-monetary units. As a result, attempts have been made to build a welfare economic bridge between cost-benefit analysis (CBA) and cost-effectiveness analysis (CEA). In this paper, we develops these attempts and finds that, while assumptions can be made to facilitate a constant willingness-to-pay per unit of health outcome, these restrictions are highly unrealistic. We develop an impossibility theorem that shows it is not possible to link CBA and CEA if: (i) the axioms of expected utility theory hold; (ii) the quality-adjusted life-year (QALY) model is valid in a welfare economic sense; and (iii) illness affects the ability to enjoy consumption. We conclude that, within a welfare economic framework, it would be unwise to rely on a link between CBA and CEA in economic evaluations.
成本效益分析（CBA）被公认为是最符合标准福利经济理论基本原则的经济评估技术。然而，由于该技术存在的问题，评估医疗保健资源分配决策的经济学家最常使用成本效益分析（CEA），其中健康效益以非货币单位表示。因此，人们试图在成本效益分析（CBA）和成本效益分析（CEA）之间搭建一座福利经济桥梁。在本文中，我们对这些尝试进行了拓展，并发现，虽然可以做出一些假设来促使每单位健康结果的支付意愿保持不变，但这些限制条件极不现实。我们提出了一个不可能性定理，该定理表明，如果满足以下条件，则无法将CBA和CEA联系起来：（i）预期效用理论的公理成立；（ii）质量调整生命年（QALY）模型在福利经济意义上是有效的；（iii）疾病会影响享受消费的能力。我们得出结论，在福利经济框架内，在经济评估中依赖CBA和CEA之间的联系是不明智的。
