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. 2019 Jan 26;10(Suppl 1):73–105. doi: 10.1017/bca.2018.29

Table 3. Key parameters and possible estimates and default assumptions.

Key parameters Possible estimates and default assumptions
Health opportunity costs of health care expenditure in each period (t) kht
  • Estimates reported in Ochalek et al. (2018) could provide initial default estimates of cost per DALY averted

  • Projections of these estimates based on estimates of health expenditure and consumption growth are possible

  • These initial estimates can be refined and updated as other country specific estimates emerge

Consumption opportunity costs of health care expenditure in each period (t) kct
  • A conservative default assumption of 1 (1 dollar spent on health care delivers 1 dollar in net production)

  • A conservative default assumption that the real value of the net production effects will grow at the same rate as consumption

Consumption value of health in each period (t) υht
  • Country specific estimates of Vht, see Robinson et al. (2019) and Robinson and Hammitt (2018)

  • Growth in Vht can be based on growth in consumption (gc) and the income elasticity of demand for health

  • A conservative scenario using an income elasticity of demand for health of 1 (Vht will grow at gc)

  • Scenario using an income elasticity of demand of 1.5

Opportunity costs for other sectors (x) in each period (t) Social rate of time preference for consumption υxt/kxt
  • Default assumption that vht/kht = υxt/kxt when considering impacts on other public sectors

rc
  • A normative assumption of zero pure time preference for social choices is not unreasonable (δ = 0)

  • Two scenarios based on alternative assumptions of inequality aversion can be used

    • A conservative scenario based on η = 1 (rc = gc)

    • Alternative scenario based on η = 2 (rc = 2gc)

  • Other scenarios can be based on evidence of why η is likely to differ in specific contexts or different judgements about gc

Catastrophic risk
  • If catastrophic risk is included it should be based an estimate of the probability of truly catastrophic events where recovery would not be possible (≤0.1%)

Macroeconomic risk
  • Use of rc without adjustment for macroeconomic risk may be a reasonable for projects with shorter time horizons (⩽30 years)

  • For longer time horizons or where macroeconomic risk is greater, declining rates may be required but should be based on uncertainty in consumption growth

Project specific risk
  • Where possible project specific risks should be included in how the time streams of consumption equivalent effects of the project are estimated

  • A qualitative indication of whether projects are likely to be strongly pro or counter cyclical should be provided

  • Further research is required on how the interaction of project specific and macroeconomic risk might be best quantified for the types of project relevant to LMICs