Lazaro Angelina
Facultad de Derecho, University of Zaragoza, Zaragoza, Spain.
Pharmacoeconomics. 2002;20(14):943-61. doi: 10.2165/00019053-200220140-00001.
Despite the theoretical arguments presented in the literature regarding discounting over the last 25 years, no satisfactory reply has yet been offered to the question of whether health consequences have to be discounted at the same rate as monetary consequences in the economic evaluation of health programmes or interventions designed to improve health. Against this background, the main objective of this paper was to review and systemise these theoretical arguments, with the aim of determining whether any of the positions identified can be accepted without reservation. Having determined that this is not possible, we investigated the rationality of discounting in the literature and, on this basis, propose a potential way to resolve the problem. Thus, we argue that the relationship between the discount of monetary and health consequences has to be determined in an indirect manner, by reference to the relationship maintained by the individual time preference rates for health and money in the context of private and social choice. Although this proposal moves the debate into the empirical field, its advantages must be weighed against the difficulties associated with the estimation of the time preferences.
尽管在过去25年的文献中提出了关于贴现的理论观点，但对于在健康项目或旨在改善健康的干预措施的经济评估中，健康后果是否必须以与货币后果相同的比率进行贴现这一问题，尚未给出令人满意的答复。在此背景下，本文的主要目的是回顾并系统化这些理论观点，以确定所确定的任何立场是否可以毫无保留地被接受。在确定这是不可能的之后，我们研究了文献中贴现的合理性，并在此基础上提出了一种解决该问题的潜在方法。因此，我们认为，货币和健康后果贴现之间的关系必须通过参考个人在私人和社会选择背景下对健康和金钱的时间偏好率所维持的关系，以间接方式来确定。尽管这一提议将辩论带入了实证领域，但其优点必须与时间偏好估计相关的困难进行权衡。
