VALUE MEASUREMENT IN CEA: FAIRNESS TO ELDERLY/DISABLED

描述（改编自摘要）：成本效益分析（CEA）具有

DESCRIPTION (adapted from the Abstract): Cost-effectiveness analysis (CEA) has been criticized for discriminating against people with disabilities, for harming the elderly, for ignoring issues of fairness, and for undervaluing the benefit of treating severely ill patients. Because the elderly often have chronic disabilities that limit the amount they can improve their quality of life with health programs, measures of the cost-effectiveness of programs targeted toward the elderly appear relatively unfavorable. We think that these problems can be overcome by distinguishing between the health related utility brought by health care programs and the societal value of those programs. The goal is to improve value measurement in CEA to make it fair to the elderly and people with disabilities. To achieve this goal, we plan to test and refine the person trade-off method (PTO) - a measure of the societal value of health care programs. In a typical PTO elicitation, a subject is asked how many people need to be cured of a health condition (e.g., severe osteoarthritis) to equal the benefit of saving ten people's lives. Several methodologic issues have arisen about the feasibility of PTO measurement. In a series of six studies, we will explore these methodologic issues as well as the cognitive processes people undergo when responding to PTO elicitations. The team proposes to conduct PTO eliciatations from the general public using face to face interviews. The primary source of subjects will be prospective jurors at the Philadelphia County and Montgomery County Courthouses and mall patrons from the Delaware Valley area. Studies 1 and 2 will explore way to improve the consistency of PTO responses. Study 3 will explore the societal value people place on preventive versus curative treatment programs. Study 4 will evaluate whether CEA undervalues treatment programs directed at saving the lives of people with chronic disabilities. Study 5 will test whether the importance people place on equity in responding to PTO elicitations is unduly influenced by cognitive biases resulting from framing effects. Study 6 will explore whether the value people place on treatment programs depends on patients' ages, and whether the importance they place on age varies across treatment programs (e.g., life saving programs versus programs that improve function or reduce pain). The goal is to evaluate whether PTO determinations can be an effective solution to the problems that arise when conventional utility assessment is applied to the evaluation of health care programs for the elderly and disabled.