Considering consumer choice in the economic evaluation of mandatory health programmes: a review.
OBJECTIVE
Governments are increasing their focus on mandatory public health programmes following positive economic evaluations of their impact. This review aims to examine whether loss of consumer choice should be included in economic evaluations of mandatory health programmes (MHP).


METHODS
A systematic literature review was conducted to identify economic evaluations of MHP, whether they discuss the impact on consumer choice and any methodological limitations.


RESULTS
Overall 39 economic evaluations were identified, of which 10 discussed the loss of consumer choice and 6 attempted to place a value on the loss of consumer choice. Methodological limitations included: measuring the marginal cost of compliance, unavailability of price elasticity estimates, the impact of income effects, double counting health impacts, biased willingness-to-pay responses, and "protest" responses. Overall it was found that the inclusion of the loss of consumer choice rarely impacted on the final outcome of the study.


CONCLUSIONS
The impact of MHP on the loss of consumer choice has largely been ignored in economic evaluations. Its importance remains uncertain due to its infrequent inclusion and significant methodological limitations. Further research regarding which methodology is best for valuing the loss of consumer choice and whether it is important to the final implementation decision is warranted.
Centre for Health Economics Research and Evaluation (CHERE), University of Technology, Sydney, PO Box 123, Broadway, NSW 2007 Sydney, Australia. Bonny.parkinson@chere.uts.edu.au
Bonny
B
Parkinson
Stephen
S
Goodall
D003362:Cost-Benefit Analysis; D005069:Evaluation Studies as Topic; D017048:Health Care Costs; D006801:Humans; D037141:Mandatory Programs / Q000191:economics* / Q000592:standards; D010349:Patient Compliance; D057240:Patient Preference