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Productivity Costs in Economic Evaluations: Past, Present, Future
Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of
whether
and
how
to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
Journal Article
Scientific Ethics: A New Approach
Science is an activity of the human intellect and as such has ethical implications that should be reviewed and taken into account. Although science and ethics have conventionally been considered different, it is herewith proposed that they are essentially similar. The proposal set henceforth is to create a new ethics rooted in science: scientific ethics. Science has firm axiological foundations and searches for truth (as a value, axiology) and knowledge (epistemology). Hence, science cannot be value neutral. Looking at standard scientific principles, it is possible to construct a scientific ethic (that is, an ethical framework based on scientific methods and rules), which can be applied to all sciences. These intellectual standards include the search for truth (honesty and its derivatives), human dignity (and by reflection the dignity of all animals) and respect for life. Through these it is thence achievable to draft a foundation of a ethics based purely on science and applicable beyond the confines of science. A few applications of these will be presented. Scientific ethics can have vast applications in other fields even in non scientific ones.
Journal Article
Ethical Efficiency
Practical and conceptual, the Responsible Research and Innovation set of books contributes to the clarification of this new requirement for all sciences and technological innovation. It covers the multiple and international responsibilities, by using various philosophical resources, mostly discussing the following topics: ethics, contingency, normative economy, freedom, corporate social responsibility (CSR), participative technological evaluation, sustainable development, geoengineering, the precautionary principle, standards, interdisciplinarity, and climate management. The ethics of efficiency must be considered with regard to the logic of action or to economic, political, legal or scientific systems. This book presents a question on the central theme of responsible research and innovation (RRI), which has an ethical influence on effective logics. The issue is to question the opportunity and modularities of an ethical effective influence on the logics of efficiency of research and innovation. From the distinction of efficiency and effectiveness, lies the problem of efficacy, the ethical accord between the two. Thus appears the possibility of taking effective responsibility with respect to systematic injustices potentially linked to this efficiency. This book proposes categories to understand the ethical implications of research and innovation processes, under the aspect of their efficacy.
eBook
Enhancement and the Ethics of Development
Much of the debate about the ethics of enhancement has proceeded according to two framing assumptions. The first is that although enhancement carries large social risks, the chief benefits of enhancement are to those who are enhanced (or their parents, in the case of enhancing the traits of children). The second is that, because we now understand the wrongs of state-driven eugenics, enhancements, at least in liberal societies, will be personal goods, chosen or not chosen in a market for enhancement services. This article argues that both framing assumptions must be rejected, once it is understood that some enhancements— especially those that are most likely to garner resources and become widespread— will increase human productivity. Once one appreciates the productivity-increasing potential of enhancements, one can begin to see that enhancement need not be primarily a zero sum affair, that the social costs of forgoing enhancements may be great, and that the state may well take an interest in facilitating biomedical enhancements, just as it does in facilitating education and other productivity-increasing traditional enhancements. Appreciating the productivity-increasing potential of enhancements also makes it possible to view the enhancement debate in a new light, through the lens of the ethics of development.
Journal Article
The Productivity Dilemma in Workplace Health Promotion
Background. Worksite-based programs to improve workforce health and well-being (Workplace Health Promotion (WHP)) have been advanced as conduits for improved worker productivity and decreased health care costs. There has been a countervailing health economics contention that return on investment (ROI) does not merit preventive health investment. Methods/Procedures. Pertinent studies were reviewed and results reconsidered. A simple economic model is presented based on conventional and alternate assumptions used in cost benefit analysis (CBA), such as discounting and negative value. The issues are presented in the format of 3 conceptual dilemmas. Principal Findings. In some occupations such as nursing, the utility of patient survival and staff health is undervalued. WHP may miss important components of work related health risk. Altering assumptions on discounting and eliminating the drag of negative value radically change the CBA value. Significance. Simple monetization of a work life and calculation of return on workforce health investment as a simple alternate opportunity involve highly selective interpretations of productivity and utility.
Journal Article
Interim analysis of sequential estimation-adjusted urn models with sample size re-estimation
Clinical trials usually involve efficient and ethical objectives. Different adaptive designs have been proposed to satisfy these needs. We combine interim analysis, the sequential estimation-adjusted urn model (SEU), and sample size re-estimation (SSR) in one clinical trial. We show that the asymptotic distribution, under the null hypothesis, of the proposed sequential statistic follows Brownian motion by simultaneously addressing the three sequential procedures (allocation of patients, urn composition, and sequential parameter estimators) and the sequential statistics with revised information time due to SSR. Therefore, to control the type I error rate, traditional critical values for sequential monitoring based on Brownian motion can be used for the proposed procedure. Numerical studies with three types of urn models demonstrate that our proposed approach can control the type I error rate well and also achieve efficient and ethical objectives.
Les études cliniques comportent des objectifs d’éthique et d’efficacité. Différents plans d’expérience adaptatifs proposés permettent de les atteindre. Les auteurs combinent dans une même étude clinique des analyses intérimaires, le modèle séquentiel d’urnes ajusté pour l’estimation, ainsi que la ré-estimation de la taille d’échantillon (RTE). Sous l’hypothèse nulle, ils montrent que la distribution asymptotique de la statistique séquentielle proposée suit un mouvement brownien en abordant les trois procédures séquentielles (attribution des patients, composition de l’urne et estimation séquentielle des paramètres) ainsi que les statistiques séquentielles avec l’information révisée due à la RTE. Ainsi, les valeurs critiques traditionnelles pour le monitoring séquentiel basées sur un mouvement brownien peuvent être utilisées pour contrôler l’erreur de type I avec la procédure proposée. Les auteurs illustrent leur approche à l’aide d’études numériques pour trois types de modèles d’urnes et montrent qu’ils peuvent bien contrôler le taux d’erreur de type I et atteindre leurs objectifs d’éthique et d’efficacité.
Journal Article
How can bedside rationing be justified despite coexisting inefficiency? The need for ‘benchmarks of efficiency’
Imperfect efficiency in healthcare delivery is sometimes given as a justification for refusing to ration or even discuss how to pursue fair rationing. This paper aims to clarify the relationship between inefficiency and rationing, and the conditions under which bedside rationing can be justified despite coexisting inefficiency. This paper first clarifies several assumptions that underlie the classification of a clinical practice as being inefficient. We then suggest that rationing is difficult to justify in circumstances where the rationing agent is or should be aware of and contributes to clinical inefficiency. We further explain the different ethical implications of this suggestion for rationing decisions made by clinicians. We argue that rationing is more legitimate when sufficient efforts are undertaken to decrease inefficiency in parallel with efforts to pursue unavoidable but fair rationing. While the qualifier ‘sufficient’ is crucial here, we explain why ‘sufficient efforts’ should be translated into ‘benchmarks of efficiency’ that address specific healthcare activities where clinical inefficiency can be decreased. Referring to recent consensus papers, we consider some examples of specific clinical situations where improving clinical inefficiency has been recommended and consider how benchmarks for efficiency might apply. These benchmarks should state explicitly how much inefficiency shall be reduced in a reasonable time range and why these efforts are ‘sufficient’. Possible strategies for adherence to benchmarks are offered to address the possibility of non-compliance.
Journal Article
Safeguarding the Public's Health: Ethical Nursing
With the landmark 2010 Future of Nursing report by the Institute of Medicine largely silent about the ethical foundation of nursing and with growing concerns about the prominence of ethical issues that arise for individuals across all roles within nursing, it is clearly time for the profession to pause and consider its ethical foundations anew. In August 2014, fifty nursing leaders participated in the national summit Nursing Ethics for the 21st Century, sponsored by The Johns Hopkins University School of Nursing and Berman Institute of Bioethics. Together, we and our colleagues identified priorities and created a blueprint for the future.
Journal Article