Does Cost-Effectiveness Fail to Give Sufficient Priority to Severity?

Abstract

AbstractThis chapter responds to the objection that allocation guided by cost-effectiveness fails to place sufficient weight on the severity of health problems. If treatments T and T′ cost the same and are equally effective, but the recipients of treatment T would be worse off if untreated, then many believe that T should be funded before T′. The chapter first distinguishes acute and chronic severity and presents data showing that survey respondents support the severity objection. But it points out ambiguities in prioritizing severity. After considering how to implement greater priority for severity, it lays out problems that undermine the intuitive appeal of prioritizing acute severity. It then criticizes the main arguments that are invoked to support the conclusion that fairness requires prioritizing chronic severity, and it argues that compassion and solidarity do not justify the severity objection. The chapter concludes with speculations concerning why so many people mistakenly endorse the severity objection.