The Moral Imperative Toward Cost-Effectiveness in Global Health

Abstract

Getting good value for the money with scarce resources is a substantial moral issue for global health. In this chapter, Toby Ord explores the moral relevance of cost-effectiveness, a major tool for capturing the relationship between resources and outcomes, by illustrating what is lost in moral terms for global health when cost-effectiveness is ignored. For example, the least effective HIV/AIDS intervention produces less than 0.1 per cent of the value of the most effective. In practical terms, this can mean hundreds, thousands, or millions of additional deaths due to a failure to prioritize. Ultimately, the author suggests that creating an active process of reviewing and analyzing global health interventions to deliver the bulk of global health funds to the very best.

What works to increase charitable donations? A meta-review with meta-meta-analysis

“…Based on findings of Butts (2019), practitioners should make potential donors more aware of the increased impacts of donation to more beneficiaries, or suggest that more effective giving (i.e., helping more people) entitles greater pleasure. At a more systemic level, some practitioners may have difficulty presenting persuasive evidence that they are deploying an effective solution to a serious problem (Ord 2013). In this case, accumulating high-quality research into the effectiveness of the organization is likely to benefit both their marketing (Butts et al 2019) and the outcomes of their efforts (Singer, Baker, and Haushofer 2019).…”

Distributing global health resources: Contemporary issues in political philosophy

“…Consider some standard approaches to deciding how we should promote health by allocating health resources (for review of key decision points in common analyses underlying these decisions, see Brock, 2004;Murray, 1996;Ubel et al, 2010). Ethicists and health economists typically argue that we should evaluate and rank alternatives by considering how well they fulfill substantive values or criteria (e.g., health maximization, health equity, priority to the worse off) (Adler, 2006;Bognar & Hirose, 2014;Cookson, 2015;Murray et al, 2012b;Ord, 2013;Ottersen, 2013).…”

“…Consider some standard approaches to deciding how we should promote health by allocating health resources (for review of key decision points in common analyses underlying these decisions, see Brock, ; Murray, 1996; Ubel et al, 2010). Ethicists and health economists typically argue that we should evaluate and rank alternatives by considering how well they fulfill substantive values or criteria (e.g., health maximization, health equity, priority to the worse off) (Adler, ; Bognar & Hirose, ; Cookson, ; Murray et al, ; Ord, ; Ottersen, ). These people might argue, for instance, in favor of giving the most to the least well‐off globally by utilizing a weighted‐needs‐based indicator or suggest that we aid those who are most deserving utilizing an impact‐based indicator.…”

“…In the Netherlands, Norway, and the UK, certain decisions about whether or not to provide financial resources for a certain treatment depend on whether it is cost‐effective enough (i.e., the decisions depend on whether one gets at least a certain amount of good health for a set amount of funds—at the moment £20–30,000 per 1 QALY in England and Wales) (Cookson, ). More broadly, substantive values of this kind enable cost‐effectiveness analysis (Adler, , ; Ord, ).…”

Effectiveness and Demandingness

“…It is estimated that $40,000 could fund either the training of one guide dog for one blind person in the United States, or approximately 2,000 blindness-reversing surgeries for those with trachoma in Africa (Ord 2013). obligations can apply even in the absence of unconditional obligations to give appealing.…”