Decision Modifiers in Economic Evaluation: The (Not-So-Simple) Case of Severity

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The concept of ‘severity’ serves an important role in healthcare priority setting, being part of jurisdictional priority frameworks and functioning as a decision modifier for cost-effectiveness thresholds in countries including the Netherlands, Norway and the United Kingdom. In this context, a decision modifier is any consideration that deviates from the premise that health outcomes—such as quality-adjusted life years—are equally weighted, irrespective of the intervention or population/disease characteristics. How to operationalize decision modifiers is an area of debate in the health economics and priority setting literature. But let’s not get ahead of ourselves. What does it mean for the circumstances of one person (or one population) to be ‘more severe’ than another? And is this differential worthy of priority status when allocating scarce resources? In this seminar, I will present findings from a mixed-methods research project that sought to identify how severity is conceptualized by members of the Norwegian general public and how these viewpoints are distributed at a population level.

David Whitehurst

Associate Professor (Faculty of Health Sciences, Simon Fraser University)

David is an economist who has specialized in the areas of health and health care throughout his career. Broadly, his research interests focus on assessing the suitability of ‘accepted’ methods in economic evaluation and outcomes measurement. A continual theme of his work has been the examination of the relative merits of different preference-weighted health and wellbeing outcomes. Other current interests include public views/preferences regarding severity-based priority setting criteria, and economic evaluation in the contexts of dyadic healthcare interventions and population health intervention research.