Division of Respiratory Medicine, University of British Columbia (UBC), Gordon and Leslie Diamond Health Care Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Legacy for Airway Health, Vancouver Coastal Health Research Institute, Canada.
Department of History and Philosophy of Science, University of Cambridge, Free School Lane Cambridge, CB2 3RH, United Kingdom; Department of Philosophy, University of South Florida, 4202 E Fowler Ave, Tampa, FL 33620, United States.
Soc Sci Med. 2024 Oct;358:117256. doi: 10.1016/j.socscimed.2024.117256. Epub 2024 Aug 16.
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.
利益相关者的参与被提议为在卫生经济学建模中适当管理有价值的决策或“价值判断”的关键策略。然而，科学哲学家以相互冲突的方式理解研究中的利益相关者的参与，并为科学中的“管理价值观”提出替代策略。此外，所有提出的管理科学中价值观的策略都提出了哲学问题和实际挑战，这些问题和挑战很难解决。因此，寻求在建模中适当告知价值判断的卫生经济学家目前没有简单的指导。需要进一步探讨卫生经济学家应该如何在建模中管理价值判断，同时考虑哲学争论和背景约束。本文讨论了管理科学中价值观的核心建议，并确定了这些建议未解决的哲学问题和实际挑战。它进一步考虑了这如何可能通过使用正在进行的名为 LEAP（终生暴露和哮喘结果预测）的建模项目中的示例来告知卫生经济学建模中的价值判断管理过程。我们的结论是，卫生经济学建模中“管理价值观”的所有策略都有其优缺点，但总体上相互兼容，这表明卫生经济学家可能会使用多种策略的组合。需要进一步研究来探索卫生经济学建模中“管理价值观”策略的效果。
