Health today versus health tomorrow: does Australia really care less about its future health than other countries do?
Nancy Devlin A C and Paul Scuffham B
+ Author Affiliations
- Author Affiliations
A Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Melbourne, Vic. 3010, Australia.
B Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, G40_8.83, Gold Coast Campus, Southport, Qld 4222, Australia. Email: p.scuffham@griffith.edu.au
C Corresponding author. Email: nancy.devlin@unimelb.edu.au
Australian Health Review 44(3) 337-339 https://doi.org/10.1071/AH20057
Submitted: 6 April 2020 Accepted: 19 May 2020 Published: 1 June 2020
Abstract
Economic evaluation provides important evidence on value for money in health care and is routinely used in health technology assessment processes. The relevant costs and benefits of health care that are considered may arise now and/or in the future, and the relative importance placed on costs and benefits in the future is reflected in the discount rate applied to them. In this paper we note that Australia appears to apply one of the highest discount rates in the world to the assessment of future healthcare benefits. At a time when healthcare systems worldwide are calling for a rebalance of effort towards prevention, Australia’s discount rate risks pulling resource allocation in precisely the opposite direction, locking in institutional short-sightedness to funding decisions.
References
[1] Department of Health, Australian Government. Guidelines for preparing a submission to the Pharmaceutical Benefits Advisory Committee, Version 5.0, September 2016. 2016. Available at: https://pbac.pbs.gov.au/content/information/files/pbac-guidelines-version-5.pdf [verified 16 May 2020].[2] Department of Health, Australian Government. Guidelines for the pharmaceutical industry on preparation of submissions to the Pharmaceutical Benefits Advisory Committee: including major submissions involving economic analyses. 1995. Available at: https://pbac.pbs.gov.au/information/printable-version-of-guidelines.html [verified 16 May 2020].
[3] Drummond M, Sculpher M, Claxton K, Stoddart G, Torrance G. Methods for the economic evaluation of health care programmes. 4th edn. Oxford: Oxford University Press; 2015.
[4] Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer AJ. Discounting and decision making in the economic evaluation of health care technologies. Health Econ 2011; 20 2–15.
| Discounting and decision making in the economic evaluation of health care technologies.Crossref | GoogleScholarGoogle Scholar | 21154521PubMed |
[5] Gravelle H, Smith D. Discounting the health effects in cost benefit and cost effectiveness analysis. Health Econ 2001; 10 587–99.
| Discounting the health effects in cost benefit and cost effectiveness analysis.Crossref | GoogleScholarGoogle Scholar | 11747043PubMed |
[6] Neumann P, Sanders G, Russell L, Siegal J, Ganiats T. Cost effectiveness in health and medicine. New York: Oxford University Press; 2017.
[7] Institute for Clinical and Economics Review (ICER). ICER’s reference case for economic evaluations: principles and rationale. 2018. Available at: http://icer-review.org/wp-content/uploads/2018/07/ICER_Reference_Case_July-2018.pdf [verified 17 May 2020].
[8] Pharmaceutical Management Agency (PHARMAC). 8.2 Recommended discount rate. In: Prescription for pharmacoeconomic analysis. 2017. Available at: https://https://www.pharmac.govt.nz/medicines/how-medicines-are-funded/economic-analysis/pfpa/8-discounting/#recommended [verified 25 May 2020].
[9] Pharmaceutical Benefits Advisory Committee. 3A.9 Uncertainty analysis: model inputs and assumptions. 2016. Available at: https://pbac.pbs.gov.au/section-3a/3a-9-uncertainty-analysis-model-inputs-and-assumptions.html [verified 20 February 2020].
[10] Haute Autorité de Santé. Choices in methods for economic evaluation. Paris: Haute Autorité de Santé; 2012.
[11] Health Information and Quality Authority. Guidelines for the economic evaluation of health technologies in Ireland. 2019. Available at: https://www.hiqa.ie/sites/default/files/2019-07/HTA-Economic-Guidelines-2019.pdf [verified 17 May 2020].
[12] National Institute for Health and Care Excellence. 5.6 Discounting. In: Guide to the methods of technology appraisal 2013. 2013. Available at: https://www.nice.org.uk/process/pmg9/chapter/the-reference-case#discounting [verified 20 February 2020].
[13] National Institute for Health and Care Excellence. Discounting of health benefits in special circumstances. 2011. Available at: https://www.nice.org.uk/guidance/ta235/resources/osteosarcoma-mifamurtide-discounting-of-health-benefits-in-special-circumstances2 [verified 25 May 2020].
[14] Scottish Medicines Consortium. Guidance to manufacturers for completion of new product assessment form (version 2.1). Glasgow: Scottish Medicines Consortium; 2007.
[15] Dental and Pharmaceutical Benefits Board (TLV). Change in the Dental and Pharmaceutical Benefits Board General Guidance on Economic Evaluations. Stockholm: Dental and Pharmaceutical Benefits Board; 2017. Available at: https://www.tlv.se/download/18.467926b615d084471ac3230c/1510316374332/TLVAR_2017_1.pdf [verified 25 May 2020]. [In Swedish].
[16] Shiroiwa T, Fukuda T, Ikeda A, Takura T, Moriwaki K. Development of an official guideline for the economic evaluation of drugs/medical devices in Japan. Value Health 2017; 20 372–8.
| Development of an official guideline for the economic evaluation of drugs/medical devices in Japan.Crossref | GoogleScholarGoogle Scholar | 28292481PubMed |
[17] Belgian Health Care Knowledge Centre. Belgian guidelines for economic evaluations and budget impact analysis. 2nd edn. Brussels: Belgian Health Care Knowledge Centre; 2012.
[18] CADTH. CADTH methods and guidelines. Guidelines for the Economic Evaluation of Health Technologies: Canada. 4th edn. 2017. Available at: www.cadth.ca/sites/default/files/pdf/guidelines_for_the_economic_evaluation_of_health_technologies_canada_4th_ed.pdf [verified 20 February 2020].
[19] Netherlands National Health Care Institute. Guideline for economic evaluations in healthcare. Diemen: National Health Care Institute; 2016. Available at: https://english.zorginstituutnederland.nl/publications/reports/2016/06/16/guideline-for-economic-evaluations-in-healthcare [verified 25 May 2020].
[20] O’Mahony JF, Paulden M. NICE’s selective application of differential discounting: ambiguous, inconsistent, and unjustified. Value Health 2014; 17 493–6.
| NICE’s selective application of differential discounting: ambiguous, inconsistent, and unjustified.Crossref | GoogleScholarGoogle Scholar | 25128041PubMed |
[21] Attema AE, Brouwer WBF, Claxton K. Discounting in economic evaluation. Pharmacoeconomics 2018; 36 745–58.
| Discounting in economic evaluation.Crossref | GoogleScholarGoogle Scholar | 29779120PubMed |
