An International Perspective on Ethical Considerations in Health Economic Evaluation: A Primer for Pediatric Psychologists

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As health care systems grapple with economic pressures, the need to demonstrate the cost-effectiveness of interventions and services in pediatric clinical psychology to inform budget decision-making is becoming more urgent. Ethical considerations in economic evaluation overlap with those of clinical research related to respect for persons, concern for welfare, and justice, and extend beyond these to include those related to the production of economic evidence by clinical psychologist researchers through the conduct of economic evaluation, and to the consumption of this evidence by budget decision-makers. Consideration of ethical issues begins with the process of selecting a technology by researchers for evaluation. Guidelines for the conduct of economic evaluation promote the maximization of benefits in terms of quality-adjusted life years (QALYs) which may introduce inequity in how these benefits are distributed across the population. Equity concerns are addressed in diverse ways across jurisdictions. A health technology assessment framework that considers economic, effectiveness, and safety evidence alongside social, legal, environmental, and ethical concerns has been adopted in public payer systems to widen the scope of information for budget decision-makers. These decision-makers often use value frameworks that regard ethical issues alongside other evidence. As clinical psychologists are increasingly compelled to demonstrate the economic value of new and existing interventions, ethical concerns are becoming more prominent in health system decision-making and pediatric clinical psychologists can play a larger role among decision-making bodies. Knowledge of these issues will prove critical to sound development of behavioral and psychosocial interventions in the U.S. and internationally.

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