10.10 Limitations of existing approaches

Synthetic indices, which are the end-product of ROI, Cost-Benefit and Cost-Utility analyses, have an appealing aesthetic quality and present a seductive format for decision-makers. However, they hide many methodological decisions in a domain where no perfect methods exist. For example, in Cost-Utility analysis, the estimation of utility varies according to the method used and whether they are measured directly or estimated using a classification system (Brousselle et al., 2011c; Brousselle & Lessard, 2011). Utility scores also vary according to the participants (Brousselle et al., 2011c; Brousselle & Lessard, 2011). Another example is the use of discounting and discount rates that are the subject of many ethical and methodological debates.

Furthermore, the rationale and methods used for giving a monetary value to life, as well as to social and environmental impacts, remain highly contested (Brousselle et al., 2016). For instance, giving a monetary value to all interventions’ results rests on the principle that everything can be valued, including intangible elements, and nothing has an intrinsic value that is incommensurable. Many economists attribute a monetary value to life, for example, but how would you value your own life if you were asked to give it a price?

Economic evaluations are aimed at making decision-making more rational. However, to facilitate those processes, we rely on elegant synthetic indicators; these can hide many ethically and methodologically controversial choices which, in the end, make the criterion used for decision-making problematic.