On discount rates for economic evaluations in global health
On discount rates for economic evaluations in global health
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DOI：
10.1093/heapol/czz127
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发表时间：
2020-02-01
影响因子：
3.2
通讯作者：
Atun, Rifat
中科院分区：
文献类型：
--
作者：
Haacker, Markus;Hallett, Timothy B.;Atun, Rifat
贴现率的选择对卫生干预措施和政策的经济评价结果具有重要影响。在全球健康领域，此类评估通常对健康结果和成本采用3%的贴现率，反映了为高收入国家（特别是美国）制定的指导方针。本文调查了这些指南对全球卫生的适用性[即重点关注低收入和中等收入国家（LMIC）]，并寻求确定最佳实践。我们的分析建立在对健康评估中贴现的学术文献、现有的关于贴现的学术或政府相关指南、对全球健康经济评估中应用的贴现率的回顾以及跨国宏观经济数据的概述之上。全球卫生领域普遍采用的每年3%的社会贴现率与最发达经济体以外的经济增长率不一致。对于低收入和中低收入国家，至少5%的贴现率更合适，对于中高收入国家，贴现率约为4%。取决于政策背景，可以有效地采用替代办法，例如由替代投资的回报或融资成本推动的办法。目前的做法可能导致系统性的偏见，高估干预措施的未来成本和健康效益。对于全球卫生的卫生经济评价，需要调整贴现准则，以考虑到低收入国家的不同经济背景。
Choices on discount rates have important implications for the outcomes of economic evaluations of health interventions and policies. In global health, such evaluations typically apply a discount rate of 3% for health outcomes and costs, mirroring guidance developed for high-income countries, notably the USA. The article investigates the suitability of these guidelines for global health [i.e. with a focus on low- and middle-income countries (LMICs)] and seeks to identify best practice. Our analysis builds on an overview of the academic literature on discounting in health evaluations, existing academic or government-related guidelines on discounting, a review on discount rates applied in economic evaluations in global health, and cross-country macroeconomic data. The social discount rate generally applied in global health of 3% annually is inconsistent with rates of economic growth experienced outside the most advanced economies. For low- and lower-middle-income countries, a discount rate of at least 5% is more appropriate, and one around 4% for upper-middle-income countries. Alternative approaches-e.g. motivated by the returns to alternative investments or by the cost of financing-could usefully be applied, dependent on policy context. The current practise could lead to systematic bias towards over-valuing the future costs and health benefits of interventions. For health economic evaluations in global health, guidelines on discounting need to be adapted to take account of the different economic contexts of LMICs.