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I have distinguished above nine distinct issues about equity and justice that arise in the construction and use of cost effectiveness analysis to minimize the burdens of disease and to maximize health outcomes. In each case the concern for equity is in my view valid and warrants some constraints on a goal of unqualified maximization of health outcomes. There has not been space here to pursue at all fully any of these nine issues regarding equity and justice — each is complex, controversial, and important. In each case, my point has been that there are important ethical and value choices to be made in constructing and using the measures; the choices are not merely technical, empirical, or economic, but moral and value choices as well. Each requires explicit attention by health policy makers using CEA. In a few cases I have indicated my own view about how the potential conflict between equity and utilitarian maximization might be resolved, but in other cases I have simply summarized briefly some arguments for giving the particular concern about equity some weight when it conflicts with maximization of utility. For some of these issues, the literature and research is at a relatively early stage and one cannot be confident about how the issues should be resolved or even about the range of plausible positions and supporting reasons on them. However, this is not grounds for ignoring the issues, but instead for getting to work on them and for ensuring that they receive explicit attention and deliberation in decisions about health resource prioritization and allocation.

DOI: 10.1007/1-4020-2127-5_16

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