Department of Industrial Engineering, 42730Jerusalem College of Technology, Jerusalem, Israel.
Disaster Research Center, IL, 42732Ariel University, Ariel, Israel.
Inquiry. 2022 Jan-Dec;59:469580221081438. doi: 10.1177/00469580221081438.
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.
每一项公共卫生支出，包括那些拯救特定人群（目标人群）生命或延长其预期寿命的支出，都需要承担成本。尽管成本效益分析（CEA）在卫生政策中经常进行，但很少讨论 CEA 的伦理合理性。此外，对于延长寿命的措施，既没有确定成本效益阈值（CET）的共识价值，也没有共识方法。在这项研究中，我们通过基于健康与财富的联系（较贫穷的人预期寿命统计上较短）的政策影响评估对 CEA 进行了伦理分析，并得出结论，CEA 不仅是一种实际需要，也是一种伦理必要。为了量化 CET，我们使用了三种独立的方法：（1）分析高风险职业薪酬的文献调查，（2）利用前景理论表明，人们将自己的生命在货币价值上的重视程度比他们的一生收入高出两倍，以及（3）对美国当前法律实践的文献调查。据我们所知，没有人使用方法（2）来确定 CET。这三种方法得出的 CET 结果非常相似，约为 1.0 ± 0.4 人均国内生产总值（GDPpc）每质量调整生命年。因此，不高于 140%的 GDPpc 的总和在统计学上足以“购买”额外的一年生命，或者，如果被剥夺，就相当于“抢夺”一年生命。因此，每质量调整生命年 140%的人均 GDP 应被视为审慎和合理地用于延长生命计划支出的上限。
