Beyond maximizing health outcomes: Incorporating fairness into priority setting for genetic screening

Aim 1. A defense of direct incorporation of equity considerations in CEAs, organized in three main parts:

1. I will argue that equity weighting is ethically justified, pragmatic and superior to alternative approaches. In this section, I will also describe and critique alternative approaches, including separate equity analyses and categorizing like claims.
2. I will compare and critique strategies that others have proposed for dealing with equity directly in CEA. Some proposed approaches include priority to the worst off or most severely ill, priority to the young, weighting all lives saved equally to avoid discrimination of the disabled, and maximizing reductions in health disparities.
3. I will propose and defend a theoretically coherent strategy for incorporating equity in CEAs.

Aim 2. How and why to incorporate fairness considerations in population genetic screening CEA, organized in three main parts.

1. I will identify unique fairness issues that arise with the distribution of access to genetic screening services.
2. Building on my systematic review of economic analyses of genetic screening, I will describe the state of the field with regard to addressing equity in published CEAs.
3. I will propose my preferred strategy for incorporating equity in genetic screening CEAs and consider how this strategy would influence the evaluation of genetic screening in priority setting.

I expect to complete a full draft of the ethics chapter of my thesis during my two-month residency. I will have a detailed outline of this chapter before coming to Brocher. Two features of the Brocher Foundation will be particularly beneficial at this stage in my dissertation writing. First, the interdisciplinary scholarly environment will provide insight on my project, which falls at the intersection of health economics, ethics, and genetics. Second, I will have the opportunity to learn about diverse international health care priority setting perspectives from scholars from around the world. During my residency, I will arrange meetings with members of the World Health Organization cost effectiveness and strategic planning WHO-CHOICE program to discuss regional contextual considerations that influence priority setting.