BMJ  2005;331:446-448 (20 August), doi:10.1136/bmj.331.7514.446

Education and debate

Need for differential discounting of costs and health effects in cost effectiveness analyses

¹ Institute for Medical Technology Assessment, Erasmus MC, PO Box 1738, 3000 DR Rotterdam, Netherlands, ² University of Groningen Institute for Drug Exploration, Groningen, Netherlands

The decision of the National Institute for Health and Clinical Excellence to abandon differential discounting of future health is a step backwards and could change funding decisions

The first 150 words of the full text of this article appear below.

Introduction

Discounting can have a strong influence on cost effectiveness ratios for priority setting, especially in preventive interventions. It is therefore crucial that appropriate discount rates are used in economic evaluations. Increasingly, it is argued that the rate for future non-monetary health effects should be below that for future costs, to account for the growing value of health effects. The previous guidelines of the National Institute for Health and Clinical Excellence (NICE) on economic evaluation were the first national guidelines to prescribe such differential discounting (6% for costs and 1.5% for effects). However, in its latest guidelines both rates are set at 3.5%, implying a lower weight for future effects.¹ We argue that this change is not based on contemporary health economic literature nor convincingly justified.

Discounting

Decisions about the resources dedicated to prevention depend on the weight given to future health in economic evaluations. Future costs and health gains are commonly . . . [Full text of this article]

Problems with current practice

Alternative strategies

Treasuring future health

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