BURDEN OF ILLNESS ESTIMATES FOR PRIORITY SETTING - A DEBATE REVISITED

This paper returns to the debate in this journal about a decade ago on the value of cost of illness (COI) and burden of illness (BOI) estima tes in priority setting. Concern is expressed that there has been a re surgence of interest in calculating and using BOI estimates in such pr iority setting. It is especially concerning that this interest seems t o have support from both the World Bank and the World Health Organisat ion (WHO) (although perhaps less so recently from the latter). It is a rgued that in terms of priorities for health services, BOI calculation s are irrelevant except possibly in the context of some (less than ide al) concept of need in support of equity. If the need basis for equity is set in terms of 'capacity to benefit', then BOI calculations becom e even less relevant. There is an argument for some research funding b eing prioritised in terms of BOI but only when it is genuinely the cas e that there is total ignorance, beyond the size of the problem, about a particular policy or disease area. Such a level of ignorance will h appen very seldom and then some fairly approximate estimates of BOI wi ll suffice. It is better to concentrate in priority setting on estimat ing the costs and benefits of marginal changes than devoting scarce an alytical resources to superfluous estimates of BOI. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.