Theory and methods
The discount rate in the economic evaluation of prevention: a
thought experiment
L Bonneux, E Birnie
Department of Public
Health, Erasmus University Rotterdam, the Netherlands
Correspondence to: Dr Bonneux, Department of Public Health, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands (bonneux{at}mgz.fgg.eur.nl)
Accepted for publication 24 August 2000
OBJECTIVES
In the
standard economic model of evaluation, constant discount rates devalue
the long term health benefits of prevention strongly. This study shows
that it is unlikely that this reflects societal preference.
DESIGNA thought
experiment in a cause elimination life table calculates savings of
eliminating cardiovascular disease from the Dutch population. A cost
effectiveness analysis calculates the acceptable costs of such an
intervention at a threshold of 18 000 Euro per saved life year.
METHODSCause specific
mortality (all cardiovascular causes of death and all other causes) and
health care costs (all costs of cardiovascular disease and all other
causes of costs) by age and male sex of 1994.
RESULTSAt a 0%
discount rate, an intervention eliminating cardiovascular disease may
cost 71 100 Euro. At the same threshold but at discount rates of 3%
or 6%, the same intervention may cost 8100 Euro (8.8 times less) or
1100 Euro (65 times less).
CONCLUSIONSThe
standard economic model needs more realistic duration dependent models
of time preference, which reflect societal preference.
Keywords: discount rate; time preference; cardiovascular disease
© 2001 by Journal of Epidemiology and Community Health
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This article has been cited by other articles:
-
Bonneux, L
(2002). How to measure the burden of mortality?. J. Epidemiol. Community Health
56: 128-131
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