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.

中文翻译：

---

全球卫生资源分配的功利主义和成本效益分析的伦理基础。


通过成本效益分析来量化和促进的效率有时会与公平和其他道德价值观相冲突，例如“救援规则”或基于权利的道德价值观。我们描述了成本效益分析的功利主义基础，并将其与其他道德原则进行比较。我们发现，功利主义虽然容易犯错，但通常优于其他选择。这主要是因为效率——在预算限制下实现健康效益的最大化——本身就是一种重要的道德价值观。其他道德框架可能是不相关的、彼此不相容的，或者具有不可接受的含义。当优先考虑效率替代方案时，我们建议量化权衡至关重要，特别是与严格效率标准背离相关的健康效益损失。以一个非洲高流行国家的艾滋病毒预防为例，我们表明，与基于成本效益的决策相比，支持基于权利的决策可能会导致每 10 万美元支出增加 92-118 例艾滋病毒感染者。