'Managing values' in health economics modelling: Philosophical and practical considerations.

Stakeholder involvement has been proposed as a key strategy for appropriately managing value-laden decisions or 'value judgments' in health economics modelling. Philosophers of science, however, conceive of stakeholder involvement in research in conflicting ways, and also propose alternative strategies for 'managing values' in science. Furthermore, all proposed strategies for managing values in science raise philosophical questions and practical challenges that are difficult to resolve. As a result, health economists who seek to appropriately inform value judgments in modelling must currently go without straightforward guidance. There is a need to further explore how health economists should manage value judgments in modelling, taking into account philosophical debates and contextual constraints. This paper discusses core proposals for managing values in science and identifies philosophical questions and practical challenges these proposals leave unresolved. It further considers how this could potentially inform processes to manage value judgments in health economics modelling, using examples from an ongoing modelling project called LEAP (Lifetime Exposures and Asthma Outcomes Projection). We conclude that all strategies to 'manage values' in health economics modelling have strengths and weaknesses, but are generally compatible with one another, suggesting that health economists may use a combination of strategies. Further research is needed to explore the effects of strategies to 'manage values' in health economics modelling.