Equity, Efficiency and Public Health: Studies in the Ethics and Economics of Vaccination Policy

Datum: 19 mei 2014

Locatie: University of Antwerp, Campus Drie Eiken, Promotiezaal - Universiteitsplein 1 - 2610 Wilrijk (Antwerpen)

Tijdstip: 13.30 uur

Organisatie / co-organisatie: Faculty of Medicine and Health Sciences

Promovendus: Jeroen Luyten

Promotor: Prof P. Beutels

Co-promotor: Prof A. Vandevelde, Prof P. Van Damme

Korte beschrijving: PhD defense Jeroen Luyten - Faculty of Medicine and Health Sciences



Abstract

In a context of scarce health care resources, which interventions should be provided by the state? Cost-effectiveness analysis (CEA) is an important methodology to inform policy makers on the efficiency of health care: how much health does an intervention offer per euro invested? In this thesis it is shown that in the Belgian context a hepatitis A vaccination program for adults would not be cost-effective.

The thesis proceeds by critically examining the normative value of cost-effectiveness ratios. First, several measurement problems are discussed, found in the way both costs and health effects are quantified in CEA. Moreover, an efficient allocation of resources can also be inequitable. A discrete choice experiment was executed to elicit the distributive preferences of the Belgian population (N=750). In general, patients’ age and responsibility for lifestyle were the most influential factors on which basis priorities were set. Prevention was found to be more valuable than cure for severe illnesses and in younger patient groups. These findings suggest that the equity assumptions underlying CEA are not in line with those of the Belgian public.

After this more general discussion on health-economic evaluation the focus is narrowed down to vaccination programs. Here, health care is not only a matter of rights, but also one of duties. The thesis discusses several arguments why individuals can have a duty towards the community to become vaccinated, and why the latter has duties to protect individuals or minority groups from discriminative or stigmatizing policies. An empirical study of the Flemish population’s preferences (N=1050) over various vaccination policy options showed that considerations of equity can indeed be perceived as more important than concerns for efficiency and effectiveness. These inherent ethical dimensions of vaccination are, in addition to the more general concerns mentioned earlier, also neglected in health-economic evaluation. It gives an additional reason to believe that the real social value of vaccination programs may be misrepresented through these analyses.