RESEARCH ARTICLE


Frameworks to Set Priorities for Treatments Based on Cost-Effectiveness and Equity



Pedro Plans-Rubio*
Public Health Agency of Catalonia, Health Departament, Barcelona, Spain.


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© Plans-Rubio et al.;

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Public Health Agency of Catalonia, Health Departament, Barcelona, Spain. Tel: 93 551 36 82; E-mail: pedro.plans@gencat.cat


Abstract

Two priority-setting frameworks to decide how to allocate limited resources among available treatments were developed, the first one based on cost-effectiveness and the second one based on cost-effectiveness and a social welfare function (SWF). The framework based on cost effectiveness gives a higher priority to therapies with lower average or incremental cost-effectiveness ratios. The framework based on cost effectiveness and a SWF takes into account social aversion to inequality in the distribution of health-related gains, and gives a higher priority to independent therapies associated with values of ε consistent with the social welfare function. The framework to set priorities based on cost effectiveness maximizes effectiveness from available resources, but in non-utilitarian societies, it could not maximize health-related social welfare. The framework based on cost-effectiveness and a SWF maximizes health-related social welfare in non-utilitarian societies when several independent and mutually exclusive therapies are available. This framework can reduce health inequalities among different groups of patients, since it reduces the cost of treating all groups of patients with at least one therapy. In conclusion, the framework based on cost effectiveness could be used to decide priorities in utilitarian societies, and the framework based on cost effectiveness and a SWF could be used in non-utilitarian societies.

Keywords: Cost-effectivenes, efficiency, equity, priority, social welfare function.