ArticlePhilosophy, ethics, and humanities in medicine : PEHM2019
Utilitarianism and the ethical foundations of cost-effectiveness analysis in resource allocation for global health.
Article in Philosophy, ethics, and humanities in medicine : PEHM, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.
- Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses.Frontiers in oncology · 2023Pooled it
- Integrating equity and justice in rheumatic heart disease policy: addressing reproductive health challenges.International journal of public health · 2026Article
- Personalized medicine and health equity: overcoming cost barriers and ethical challenges.International journal for equity in health · 2025Review
- Beyond cost-effectiveness: a reflective commentary on adapting global health technology assessment for equity considerations in South Africa and other LMICs.International journal for equity in health · 2025Article
- Privacy, Exploitation and Global Disease Surveillance: Can We Justly Prevent the Next Pandemic?Public health ethics · 2025Article
- Economic analyses in cardiac electrophysiology: from clinical efficacy to cost utility.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Do Moral Judgments in Moral Dilemmas Make One More Inclined to Choose a Medical Degree?Behavioral sciences (Basel, Switzerland) · 2023Article
- Breaking bad news in the era of artificial intelligence and algorithmic medicine: an exploration of disclosure and its ethical justification using the hedonic calculus.AI and ethics · 2022Article
- Assessing the value of orphan drugs using conventional cost-effectiveness analysis: Is it fit for purpose?Orphanet journal of rare diseases · 2022Review
- Population genomic screening: Ethical considerations to guide age at implementation.Frontiers in genetics · 2022Review
- Prioritarian principles for digital health in low resource settings.Journal of medical ethics · 2020Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Efficiency as quantified and promoted by cost-effectiveness analysis sometimes conflicts with equity and other ethical values, such as the "rule of rescue" or rights-based ethical values. We describe the utilitarian foundations of cost-effectiveness analysis and compare it with alternative ethical principles. We find that while fallible, utilitarianism is usually superior to the alternatives. This is primarily because efficiency - the maximization of health benefits under a budget constraint - is itself an important ethical value. Other ethical frames may be irrelevant, incompatible with each other, or have unacceptable implications. When alternatives to efficiency are considered for precedence, we propose that it is critical to quantify the trade-offs, in particular, the lost health benefits associated with divergence from strict efficiency criteria. Using an example from HIV prevention in a high-prevalence African country, we show that favoring a rights-based decision could result in 92-118 added HIV infections per $100,000 of spending, compared to one based on cost-effectiveness.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.