Abstract
The primary focus of this paper is to offer guidance on the analysis of time streams of effects that a project may have so that they can be discounted appropriately. This requires a framework that identifies the common parameters that need to be assessed, whether conducting cost-effectiveness or benefit-cost analysis. The quantification and conversion of the time streams of different effects into their equivalent health, health care cost or consumption effects avoids embedding multiple arguments in discounting policies. This helps to identify where parameters are likely to differ in particular contexts, what type of evidence would be relevant, what is currently known and how this evidence might be strengthened. The current evidence available to support the assessment of the key parameters is discussed and possible estimates and default assumptions are suggested. Reporting the results in an extensive way is recommended. This makes the assessments required explicit so the impact of alternative assumptions can be explored and analysis updated as better estimates evolve. Some projects will have effects across different countries where some or all of these parameters will differ. Therefore, the net present value of a project will be the sum of the country specific net present values rather than the sum of effects across countries discounted at some common rate.
Highlights
A decision to introduce a policy or implement a project may offer some immediate health benefits for the current population but, in many circumstances, the health benefits will occur in future periods
Other projects are intended to reduce the risk of future events for the current population and/or reduce risks for future incident patients, so the health benefits they offer will not be fully realized for many years
The primary focus of this paper is to offer guidance on the appropriate analysis of time streams of the effects that a project may have so that they can be discounted appropriately
Summary
A decision to introduce a policy (e.g., public health, educational, environmental etc.) or implement a project (e.g., a health technology or programme of care for a particular indication) may offer some immediate health benefits for the current population but, in many circumstances, the health benefits will occur in future periods. The intention is to offer clarity about principles, the key parameters required and the evidence currently available to inform assessments of them, so that decision makers in lowand middle-income countries (LMICs) and other stakeholders, are better placed to judge what would be an appropriate analysis of the time streams of the effects that a project may have and the discount policy to apply to them in a particular context This includes how global bodies, which make recommendations (e.g., World Health Organisation), purchase health technologies (e.g., Global Fund) or prioritize the development of new ones (e.g., Bill and Melinda Gates Foundation), should judge the value of projects which have effects in many different settings where appropriate discounting of costs and benefits are likely to differ. Some suggestions of priorities for further research are made
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