I think HTA offers a concrete path to better emulate moral uncertainty and pluralism, though I worry it could soften and blunt the insight EA contributes through its focus on cost-effectiveness. Do you think this is a real trade-off? Is pluralism better emulated at the field-level, such that it is served by EA continuing its narrow focus?
I liked the other recent CGD blog on PEPFAR, a case where cost-effectiveness analysis was misleading. Seemingly the failures were strategic—not considering how budgetary constraints could be loosened nor how prices could be affected by major efforts. Do you think HTA would have fared better?
First off—I see HTA as a kind of process wrapper for cost-effectiveness analysis. So in a sense It’s CEA+, rather than an alternative.
I’m not sure I followed you points about moral uncertainty and emulation of pluralism. Would you try again to say what you mean?
On Justin’s blog, CGD welcomes—even encourages—a diversity of views within its staff. I don’t agree with everything in this blog. For example HTA (which as I say, encompasses CEA) is precisely the tool used by many countries in price negotiation. I think there will be a follow up CGD blog with the opposing view, but I would say that CEA/HTA is now adopted by a large and increasing number of countries to inform health policy. If we’re saying it’s good enough domestic policy but not aid policy, we need to be really clear why.
Thanks! To clarify about moral uncertainty/pluralism—a caricatured EA approach might use CEA to evaluate how well different interventions maximise units of a particular benefit (e.g. DALYs, lives saved, ROI), and then follow those results to fulfil a consequentialist ethic. HTA seems like a method that could additionally weight equity, fairness, or benefit to the worst off, such that it would be more inclusive of prioritarian or justice-based views. HTA’s greater emphasis on participation by different stakeholders also seems more amenable to considering a plurality of worldviews, rather than reliance on those of a small set of donors and analysts.
So all that sounds quite good to me, but I’m aware that there may be a trade-off where EA loses some its weirdness, such that high-impact but niche interventions and cause areas would be neglected if EA became more like the rest of the aid landscape. I’m not sure what to think here.
Ok gotcha this time. Similar to some of the response to Jason below I would say that the assessment of value and the assessment of gaps etc are separate steps. We shouldn’t think about adopting a value framework because it allows us to find a practical niche. I suppose it does beg the question; whose value framework should we use? I don’t have that answer, but I do think that it links to the 4th difference in my blog; about institutionalisation and participation.
Btw, you imply that the rest of the aid landscape uses this HTA-like approach to prioritisation.. Sadly this is certainly not the case! I worked in the UK Department for International Development for several years, in a team that was tasked with providing evidence to the rest of the organisation. We did our best but it was a long way from perfect. Indeed I do see a significant opportunity for EA movement and organisations to influence other donors to take a more systematic, evidence-informed approach. For me this absolutely does mean using cost-effectiveness—but it means using it not in a blunt way but as part of an appropriate process and so that—wherever possible—we work with, not around, local systems and institutions.
Thanks for this, I found it interesting!
I think HTA offers a concrete path to better emulate moral uncertainty and pluralism, though I worry it could soften and blunt the insight EA contributes through its focus on cost-effectiveness. Do you think this is a real trade-off? Is pluralism better emulated at the field-level, such that it is served by EA continuing its narrow focus?
I liked the other recent CGD blog on PEPFAR, a case where cost-effectiveness analysis was misleading. Seemingly the failures were strategic—not considering how budgetary constraints could be loosened nor how prices could be affected by major efforts. Do you think HTA would have fared better?
Hi Ben
First off—I see HTA as a kind of process wrapper for cost-effectiveness analysis. So in a sense It’s CEA+, rather than an alternative.
I’m not sure I followed you points about moral uncertainty and emulation of pluralism. Would you try again to say what you mean?
On Justin’s blog, CGD welcomes—even encourages—a diversity of views within its staff. I don’t agree with everything in this blog. For example HTA (which as I say, encompasses CEA) is precisely the tool used by many countries in price negotiation. I think there will be a follow up CGD blog with the opposing view, but I would say that CEA/HTA is now adopted by a large and increasing number of countries to inform health policy. If we’re saying it’s good enough domestic policy but not aid policy, we need to be really clear why.
Thanks,
Thanks! To clarify about moral uncertainty/pluralism—a caricatured EA approach might use CEA to evaluate how well different interventions maximise units of a particular benefit (e.g. DALYs, lives saved, ROI), and then follow those results to fulfil a consequentialist ethic. HTA seems like a method that could additionally weight equity, fairness, or benefit to the worst off, such that it would be more inclusive of prioritarian or justice-based views. HTA’s greater emphasis on participation by different stakeholders also seems more amenable to considering a plurality of worldviews, rather than reliance on those of a small set of donors and analysts.
So all that sounds quite good to me, but I’m aware that there may be a trade-off where EA loses some its weirdness, such that high-impact but niche interventions and cause areas would be neglected if EA became more like the rest of the aid landscape. I’m not sure what to think here.
Ok gotcha this time. Similar to some of the response to Jason below I would say that the assessment of value and the assessment of gaps etc are separate steps. We shouldn’t think about adopting a value framework because it allows us to find a practical niche. I suppose it does beg the question; whose value framework should we use? I don’t have that answer, but I do think that it links to the 4th difference in my blog; about institutionalisation and participation.
Btw, you imply that the rest of the aid landscape uses this HTA-like approach to prioritisation.. Sadly this is certainly not the case! I worked in the UK Department for International Development for several years, in a team that was tasked with providing evidence to the rest of the organisation. We did our best but it was a long way from perfect. Indeed I do see a significant opportunity for EA movement and organisations to influence other donors to take a more systematic, evidence-informed approach. For me this absolutely does mean using cost-effectiveness—but it means using it not in a blunt way but as part of an appropriate process and so that—wherever possible—we work with, not around, local systems and institutions.