Results from economic evaluations of long-term outcomes are strongly dependent on the chosen discount rate. A recent review of national guidelines for evaluation of healthcare interventions finds that “the level of currently used discount rates seems relatively high in many countries”. However, this conclusion comes from a comparison to rates derived or observed for investments in safe assets, while rate of return requirements are typically considerably higher when investment involves risk. This paper reviews recent literature on how to account for project-specific risk in determination of the social rate of discount and discusses implications for economic evaluation of healthcare interventions. It concludes that the available empirical evidence strongly suggests that the demand for and consumer value of health and healthcare is co-variant with income, which therefore implies that there is a non-diversifiable risk component of health-related investment.

长期结果的经济评估结果很大程度上取决于所选的贴现率。最近对医疗干预评估国家指南的审查发现，“许多国家目前使用的折扣率水平似乎相对较高”。然而，这一结论来自与安全资产投资所得出或观察到的利率的比较，而当投资涉及风险时，回报率要求通常要高得多。本文回顾了最近关于如何在确定社会折扣率时考虑项目特定风险的文献，并讨论了对医疗保健干预措施的经济评估的影响。