, Volume 22, Issue 18, pp 1171–1179 | Cite as

Valuing prevention through economic evaluation

Some considerations regarding the choice of discount model for health effects with focus on infectious diseases
  • Jasper M. BosEmail author
  • Philippe Beutels
  • Lieven Annemans
  • Maarten J. Postma
Current Opinion


In cost-effectiveness analysis, the valuing of costs and health effects over time remains a controversial issue. The debate mostly focuses on whether the discount rates for health and money should be equal and which discounting model and time preferences are most appropriate. In this paper we add to the debate by arguing that the assessment of effectiveness of a preventive intervention may influence the choice of the discounting procedure for health.

Health effects in cost-effectiveness analysis are commonly expressed in life-years gained, QALYs gained or lives saved. These denominators are only indirect and partial measures of the effects of a preventive intervention. The actual effect of the intervention is a reduction of the risk of mortality and morbidity in a given period of time. This risk reduction will not always coincide with the moment at which the impact on (quality-adjusted) life-years gained is made (i.e. at risk exposure), for example when preventing chronic disease with an asymptomatic stage. In this paper we show that truly acknowledging the origin of health benefits could have implications for the discounting procedure. We present a discounting model that adequately focuses on the reduction of risk. This model recognises the potential interpretation of risk reduction for infection as an economic good to be acquired with associated mortality reductions as later indirect effects. This implies that our suggested discounting model focuses on the moment(s) of risk reduction. A numerical example illustrates our approach. We discuss the associated potential implications for public health policy and discuss how the effects of the intervention can be additionally corrected for societal preferences.


Risk Reduction Discount Rate Marginal Utility Time Preference Social Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors wish to thank Bernhard van den Berg for his comments on earlier versions of this paper. Jasper Bos was also employed by The Netherlands Vaccine Institute, Bilthoven, The Netherlands while constructing this article. The authors have no conflicts of interest that are directly relevant to the content of this article.


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Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Jasper M. Bos
    • 1
    Email author
  • Philippe Beutels
    • 2
    • 3
    • 4
  • Lieven Annemans
    • 5
    • 6
  • Maarten J. Postma
    • 1
  1. 1.Groningen University Institute for Drug ExplorationUniversity of GroningenGroningenThe Netherlands
  2. 2.Centre for the Evaluation of Vaccination, Epidemiology and Community MedicineUniversity of AntwerpAntwerpBelgium
  3. 3.Centre for Health Economics Research and EvaluationUniversity of TechnologySydneyAustralia
  4. 4.National Centre for Immunisation Research and Surveillance, Royal Alexandra Children’s HospitalUniversity of SydneySydneyAustralia
  5. 5.Department of Public HealthGhent UniversityGhentBelgium
  6. 6.IMS Health, Health Economics and Outcomes ResearchBrusselsBelgium

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