Monetising health: how different methodologies impact economic evaluation and decision-making

Abstract Issue/problem The economic evaluation of health policies requires health metrics, preferably including both morbidity and mortality, such as DALYs or QALYs. The conversion of these metrics into monetary values and how discount rates are used can affect both results and public policy decisions. In addition, the lack of harmonisation between countries and using different methods makes comparing or transferring policies difficult. This problem is particularly relevant to the efficiency of evaluation and transferability of public policies, including environmental policies. Description of the problem We evaluated different practices in policy evaluation, particularly environmental policies, how different monetisation and discounting approaches affect the results of economic evaluations. This covers different steps, from the measurement of health, its calculation at population level, the method itself), the values for monetisation and the application of discounting. Key questions included: What health metrics are used and how is health monetised? What different approaches to discounting are taken? What is the impact on policy evaluation results? Results Different practices show that the choice of monetisation and discounting methods significantly affects the results of evaluations. The same context or policy using different methods generates considerably different values and estimates, affecting investment priorities. There is also significant heterogeneity between countries and their guidelines for economic evaluations. Lessons learnt The results clearly show that transparency and detail in monetisation and discounting methods are essential to ensure methodologically sound and comparable economic analyses. For the transferability of public policies, it is recommended that practices be discussed and harmonised between nearby countries, which can be the first step towards making informed decisions and increasing the efficiency of public policies. Key messages • Different methods of monetising and discounting health metrics generate considerably different results in economic evaluations. • Transparency and harmonisation are crucial for potentially transferable economic evaluations and more efficient public policies.