Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, Bangor University, Bangor, Gwynedd, LL57 2PZ, UK.
Appl Health Econ Health Policy. 2021 Sep;19(5):653-664. doi: 10.1007/s40258-021-00653-5. Epub 2021 May 31.
Health economists are currently debating, with some suspicion, the relative merits of cost-benefit analysis (CBA), grounded in theoretical welfare economics, and the proliferation of social return on investment (SROI), a pragmatic approach of developing a triple-bottom line (social, environmental and financial), but not grounded in welfare theory. We argue, in rather existential terms, that there is a need to understand the role of heuristics, or prior beliefs, in current 'best practice' in CBA and SROI. A taxonomy of CBA and SROI is presented, which summarises the origins of the methods, reporting guidance, publication checklist of quality of reporting, who is wanting these analytical approaches, and policy decision rule present. We argue that a bottom-up SROI is best thought of as localised CBA, building stakeholder involvement right into the framing of SROI, perhaps addressing or mitigating the effects of prior heuristics in top-down CBA. Behavioural CBA and social CBA recognise that people are not rational and that sources of value other than willingness to pay may best reflect social values. Standardisation of SROI and comparison with CBA may illuminate the role of prior heuristics and seek to better reflect social value in weighing up the costs and benefits of public health interventions at both a local and societal level.
健康经济学家目前正在对成本效益分析（CBA）和社会投资回报率（SROI）的相对优点进行辩论，前者基于理论福利经济学，后者是一种实用的方法，用于制定三重底线（社会、环境和财务），但不基于福利理论。我们用相当存在主义的术语争辩说，需要了解启发式或先验信念在当前 CBA 和 SROI 的“最佳实践”中的作用。本文提出了 CBA 和 SROI 的分类法，总结了方法的起源、报告指南、报告质量的发布清单、谁需要这些分析方法以及现有的政策决策规则。我们认为，自下而上的 SROI 最好被视为本地化的 CBA，将利益相关者的参与直接纳入 SROI 的框架中，或许可以解决或减轻自上而下的 CBA 中先验启发式的影响。行为 CBA 和社会 CBA 认识到人们并非理性的，并且除了支付意愿之外，其他价值来源可能更能反映社会价值。SROI 的标准化和与 CBA 的比较可能会阐明先验启发式的作用，并寻求更好地反映社会价值，在权衡地方和社会层面的公共卫生干预措施的成本和收益。
