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Valuing Health for Regulatory Cost-Effectiveness Analysis PDF

381 Pages·2006·1.06 MB·English
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VALUING HEALTH FOR REGULATORY COST-EFFECTIVENESS ANALYSIS Wilhelmine Miller, Lisa A. Robinson, and Robert S. Law rence, Editors Committee to Evaluate Measures of Health Benefits fo r Environmental, Health, and Safety Regulation Board on Health Care Services INSTITUTE OF MEDICINE OF THE NA TIONA£ ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu THE NATIONAL ACADEMIES PRESS 500 FIFTH STREET, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 282-99-0045 between the National Academy of Sciences and Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Valuing health for regulatory cost-effectiveness analysis / Wilhelmine Miller, Lisa A. Robinson, and Robert S. Lawrence, editors ; Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation, Board on Health Care Services. p. ; cm. Includes bibliographical references and index. ISBN 0-309-10077-1 (casebound book) 1. Medical care—Cost effectiveness—Research—Methodology. 2. Cost effectiveness. I. Miller, Wilhelmine. II. Robinson, Lisa A. III. Lawrence, Robert S., 1938- . IV. Institute of Medicine (U.S.). Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation. [DNLM: 1. Cost-Benefit Analysis—methods—United States. 2. Health Policy—economics—United States. 3. United States Government Agencies —United States. WA 540 AA1 V215 2006] RA410.5.V35 2006 362.1068′1—dc22 2006001486 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org COMMITTEE TO EVALUATE MEASURES OF HEALTH BENEFITS FOR ENVIRONMENTAL, HEALTH, AND SAFETY REGULATION ROBERT S. LAWRENCE (Chair), Associate Dean for Professional Practice and Programs and Edyth Schoenrich Professor of Preventive Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland HENRY A. ANDERSON, Chief Medical Officer, Environmental and Occupational Disease Epidemiologist, Wisconsin Division of Public Health, Madison RICHARD T. BURNETT, Senior Research Scientist, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada CARL F. CRANOR, Professor of Philosophy, University of California, Riverside MAUREEN L. CROPPER, Professor, University of Maryland, and Lead Economist, The World Bank, Washington, DC NORMAN DANIELS, Professor of Ethics and Population Health, Harvard School of Public Health, Boston, Massachusetts DENNIS G. FRYBACK, Professor of Population Health Sciences and Industrial Engineering, Department of Population Health Sciences, University of Wisconsin, Madison ALAN M. GARBER, Staff Physician, Veterans Affairs Palo Alto Health Care System; Henry J. Kaiser, Jr. Professor and Professor of Medicine, Director, Center for Health Policy, and Director, Center for Primary Care and Outcomes Research, Stanford University, Stanford, California MARTHE R. GOLD, Arthur C. Logan Professor and Chair, Department of Community Health and Social Medicine, City University of New York Medical School, New York JAMES K. HAMMITT, Professor of Economics and Decision Sciences and Director, Harvard Center for Risk Analysis, Harvard University, Boston, Massachusetts LISA I. IEZZONI, Professor of Medicine, Harvard Medical School, and Co-Director of Research, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts PETER D. JACOBSON, Professor of Health Law and Policy and Director, Center for Law, Ethics, and Health, University of Michigan School of Public Health, Ann Arbor EMMETT KEELER, Senior Mathematician and Professor of Health Economics, RAND, Santa Monica, California WILLARD G. MANNING, Professor, Harris School of Public Policy Studies, The University of Chicago, Chicago, Illinois v CHARLES POOLE,* Associate Professor, Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill DAVID A. SCHKADE, Jerome Katzin Professor, Rady School of Management, University of California, San Diego ADVISERS TO THE COMMITTEE ALAN KRUPNICK, Senior Fellow and Director, Quality of the Environment, Resources for the Future, Washington, DC JUDITH L. WAGNER, Scholar-in-Residence, Institute of Medicine, Washington, DC MILTON C. WEINSTEIN, Henry J. Kaiser Professor of Health Policy and Management, Harvard School of Public Health and Center for Risk Analysis, Boston, Massachusetts IOM Staff Wilhelmine Miller, Project Director Ryan L. Palugod, Research Assistant Principal Consultant Lisa A. Robinson, Independent Consultant *Served from March 2004 to June 2005. vi Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with proce- dures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: ELENA ANDRESEN, Professor of Epidemiology, University of Florida, College of Public Health and Health Professions, and Research Health Scientist, North Florida/South Georgia VA Medical Center, Gainesville DAVID A. ASCH, Eilers Professor of Health Care Management and Economics, Executive Director, Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylva- nia, Philadelphia TRUDY A. CAMERON, Professor of Economics, University of Oregon, Eugene LELAND B. DECK, Senior Economist, U.S. Environmental Protection Agency (retired) and Vice President, Abt Associates (retired), Rock- ville, Maryland vii viii REVIEWERS AMY D. KYLE, Research Scientist and Lecturer, Environmental Health Sciences Division, School of Public Health, University of California, Berkeley JOSEPHINE MAUSKOPF, Global Director, Health Economics, RTI- International, Research Triangle Park, North Carolina THOMAS O. MCGARITY, Professor, University of Texas School of Law, Austin RICHARD D. MORGENSTERN, Senior Fellow, Resources for the Future, Inc., Washington, DC CHARLES E. PHELPS, Provost, University of Rochester, Rochester, New York MICHAEL STOTO, Senior Statistical Scientist and Associate Director for Public Health, Center for Domestic and International Health Se- curity, The RAND Corporation, Arlington, Virginia CASS SUNSTEIN, Karl N. Llewellyn Distinguished Service Professor of Jurisprudence, School of Law, The University of Chicago, Chi- cago, Illinois PETER UBEL, Associate Professor of Internal Medicine, Director, Pro- gram for Improving Health Care Decisions, and Staff Physician, Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor ROBERT WACHBROIT, Professor of Philosophy, Maryland School of Public Policy, University of Maryland, College Park JONATHAN B. WIENER, Professor of Law, Environmental Policy, and Public Policy Studies, Duke University, and Founding Director, Center for Environmental Solutions, Durham, North Carolina Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by John C. Bailar III, Profes- sor Emeritus, The University of Chicago, and Louise B. Russell, Research Professor, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey. Appointed by the NRC and Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully con- sidered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. Preface Valuing Health for Regulatory Cost-Effectiveness Analysis responds to several important analytical and policy challenges. These include how to estimate the health-related effects of regulatory interventions to reduce environmental, health, and safety risks; how to conduct informative cost- effectiveness analyses (CEAs) of such interventions prospectively; and how to use the results of CEAs and of other kinds of economic analyses in public policy decisions about regulating risks to human health and safety. In 2003 John D. Graham, the Administrator of the Office of Information and Regu- latory Affairs in the Office of Management and Budget, asked the Institute of Medicine (IOM) to convene an expert consensus committee to address these questions. A consortium of federal regulatory and health policy of- fices and agencies supported this effort financially and, equally essentially, with information and analytic expertise generously provided to the study committee throughout the project. This report of the Committee to Evaluate Measures of Health Benefits for Environmental, Health, and Safety Regulation is the latest in a series by the IOM and the National Research Council (NRC) of The National Acad- emies that have addressed risk assessment and communication; economic evaluation of environmental, health, and safety risks; and measurement of population health. These precursor reports include the NRC reports Risk Assessment in the Federal Government: Managing the Process (1983); Improving Risk Communication (1989); Valuing Health Risks, Costs, and Benefits for Environmental Decision Making: Report of a Conference (1990); and Estimating the Public Health Benefits of Proposed Air Pollu- ix

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