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COST, CONTEXT, AND DECISIONS IN HEALTH ECONOMICS AND HEALTH TECHNOLOGY ASSESSMENT

  • Anthony J. Culyer (a1)

Abstract

Objectives:

This study is an attempt to demystify and clarify the idea of cost in health economics and health technology assessment (HTA).

Methods:

Its method draws on standard concepts in economics. Cost is a more elusive concept than is commonly thought and can be particularly elusive in multidisciplinary territory like HTA.

Results:

The article explains that cost is more completely defined as opportunity cost, why cost is necessarily associated with a decision, and that it will always vary according to the context of that decision: whether choice is about inputs or outputs, what the alternatives are, the timing of the consequences of the decision, the nature of the commitment to which a decision maker is committed, who the decision maker is, and the constraints and discretion limiting or liberating the decision maker. Distinctions between short and long runs and between fixed and variable inputs are matters of choice, not technology, and are similarly context-dependent. Harms or negative consequences are, in general, not costs. Whether so-called “clinically unrelated” future costs and benefits should be counted in current decisions again depends on context.

Conclusions:

The costs of entire health programs are context-dependent, relating to planned rates of activity, volumes, and timings. The implications for the methods of HTA are different in the contexts of low- and middle-income countries compared with high-income countries, and further differ contextually according to the budget constraints (fixed or variable) facing decision makers.

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Copyright

Footnotes

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I am grateful for the comments of three anonymous reviewers and for discussions with and comments from Kalipso Chalkidou, Karl Claxton, Richard Cookson, Mike Drummond, Ali McGuire, Alec Morton, Mark Pauly, Adrian Towse, and Platonas Yfantopoulos.

Footnotes

References

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1.Alchian, AA. Economic forces at work. Indianapolis: Liberty Press; 1977:273299.
2.Ferraro, PJ, Taylor, LO. (2005) Do economists recognize an opportunity cost when they see one? A dismal performance from the dismal science. 2005. http://jfzuluaga.com/wp-content/uploads/CostoDeOportunidad.pdfdoi:10.2202/1538-0645.1469 (accessed September 28, 2018).
3.Frank, RH, Bernanke, BS. Principles of microeconomics. New York: McGraw-Hill/Irwin; 2001.
4.Parkin, M. Opportunity cost: A re-examination. J Econ Educ. 2016;47:1222. doi:10.1080/00220485.2015.1106361.
5.von Wieser, F. Natural value. London and New York: Macmillan; 1893.
6.Robbins, LC. Remarks upon certain aspects of the theory of costs. Econ J. 1934;44:118.
7.Buchanan, JM. Cost and choice: An inquiry in economic theory. Chicago: University of Chicago Press; 1969.
8.Wiseman, J. Cost, choice and political economy. Cheltenham: Edward Elgar; 1989.
9.Robbins, LC. An essay on the nature and significance of economic science. London and New York: Macmillan; 1932.
10.Campillo-Artero, C, Puig-Junoy, J, Culyer, AJ. Does MCDA trump CEA? Appl Health Econ Health Policy. 2018. https://doi.org/10.1007/s40258-018-0373-y (accessed September 28, 2018).
11.Jevons, WS. The theory of political economy (reprint of 1931 edition). Charlottesville: Ibis; 1871.
12.Marshall, A. Principles of economics. London and New York: Macmillan; 1890.
13.Wicksteed, PH. The common sense of political economy (1910). London: Routledge and Kegan Paul; 1933.
14.Claxton, K, Martin, S, Soares, M, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19:1503.
15.Culyer, AJ. Deliberative processes. London: Office of Health Economics; 2009.
16.Wilkinson, T, Claxton, KP, Sculpher, MJ, et al. The International Decision Support Initiative reference case for economic evaluation: An aid to thought. Value Health. 2016;19:921928.
17.Morton, A, Adler, A, Bel, D, et al. Unrelated future costs and unrelated future benefits: Reflections on NICE guide to the methods of technology appraisal. Health Econ. 2016;25:933938.
18.HM Treasury. The Green Book: Appraisal and evaluation in central government. London: TSO; 2003 (updated 2018). https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/685903/The_Green_Book.pdf (accessed July 22, 2018).
19.National Institute for Health and Social Care. Guide to the methods of technology appraisal. London: NICE. https://www.nice.org.uk/article/pmg9/chapter/foreword (accessed July 22, 2018).
20.Fenwick, E, Claxton, K, Sculpher, M. The value of implementation and the value of information: Combined and uneven development. Med Decis Making. 2007;28:2132.
21.Smith, LA. The broad gauge story. 1985. http://lionels.orpheusweb.co.uk/RailSteam/GWRBroadG/BGHist.html (accessed February 23, 2018).
22.Coase, RH. The problem of social cost. J Law Econ. 1960;3:144.

Keywords

COST, CONTEXT, AND DECISIONS IN HEALTH ECONOMICS AND HEALTH TECHNOLOGY ASSESSMENT

  • Anthony J. Culyer (a1)

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