The (Ir)relevance of Group Size in Health Care Priority Setting: A Reply to Juth

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• 作者：Lars Sandman ; Erik Gustavsson
• 关键词：Priority setting ; Orphan drugs ; Rare diseases ; Equality ; Formal equality ; Justice ; Cost ; effectiveness
• 刊名：Health Care Analysis
• 出版年：2017
• 出版时间：March 2017
• 年：2017
• 卷：25
• 期：1
• 页码：21-33
• 全文大小：404KB
• 刊物类别：Medicine
• 刊物主题：Public Health; Philosophy of Medicine; Ethics; Health Informatics;
• 出版者：Springer US
• ISSN：1573-3394
• 卷排序：25

文摘

How to handle orphan drugs for rare diseases is a pressing problem in current health-care. Due to the group size of patients affecting the cost of treatment, they risk being disadvantaged in relation to existing cost-effectiveness thresholds. In an article by Niklas Juth it has been argued that it is irrelevant to take indirectly operative factors like group size into account since such a compensation would risk discounting the use of cost, a relevant factor, altogether. In this article we analyze Juth’s argument and observe that we already do compensate for indirectly operative factors, both outside and within cost-effectiveness evaluations, for formal equality reasons. Based on this we argue that we have reason to set cost-effectiveness thresholds to integrate equity concerns also including formal equality considerations. We find no reason not to compensate for group size to the extent we already compensate for other factors. Moreover, groups size implying a systematic disadvantage also on a global scale, i.e. taking different aspects of the health condition of patients suffering from rare diseases into account, will provide strong reason for why group size is indeed relevant to compensate for (if anything).