In a previous blog post, we described how we use cost-effectiveness analyses when deciding which charities to recommend to donors.

Today, we published a report that discusses how GiveWell and other actors, such as governments and global health organizations, approach one of the most subjective and uncertain inputs into cost-effectiveness analyses: how to morally value different good outcomes.

For example, GiveDirectly, one of GiveWell’s seven top charities, increases recipients’ consumption, while the primary benefit we see from our top charity the Against Malaria Foundation is that it averts the deaths of young children. How can one make a direct comparison between the amount of “good” achieved by each of these charities?

GiveWell does this by assigning quantitative “moral weights” to different outcomes in our cost-effectiveness analyses. As a check on how sensitive our recommendations are to our moral assumptions, we investigated how others typically answer these questions in their cost-effectiveness analyses.

For a full discussion of the findings from our investigation, see our detailed report.

The summary of the report is:

We focus on the following questions:

• Why does GiveWell explicitly include moral weights in our cost-effectiveness analyses, and how do we decide on moral weights?
• Is there a “standard” approach to moral weights in cost-effectiveness analyses? How do other actors, such as governments and the World Health Organization, make these judgments?
• How much would GiveWell’s cost-effectiveness analyses change if we took a “standard” approach to moral weights?

In brief:

• We include moral weights in our cost-effectiveness analyses because they are an important part of any giving decision and we think it is valuable to be transparent about them. The moral weights that drive our cost-effectiveness estimates are based on our staff’s personal values.
• Governments and other prominent actors often use “value of a statistical life” estimates to compare the value of improving health relative to raising incomes. These estimates often imply that a year of healthy life is roughly 2-3x as valuable as a year of doubling someone’s income. However, there is little relevant research to inform such estimates in low- and middle-income country (LMIC) contexts; we understand that how income is valued relative to health may shift when a population is much poorer.
• There does not seem to be a standard approach for comparing the value of life at different ages; the most commonly used framework that we have seen (the disability-adjusted life year framework) explicitly does not provide judgments on this topic. Nevertheless, most other analyses that we have seen assume that averting death during childhood is about 1-2x more valuable than averting death during adulthood.
• Our initial analysis suggests that using relatively “standard” moral weight assumptions (i.e., the assumptions in the previous two bullet points) instead of our staff’s moral weights would not change our overall view of the relative cost-effectiveness of our current top charities. It may affect how we view some interventions in the future, particularly those that disproportionately focus on averting deaths for young children or adults. We plan to include explicit comparisons between staff moral weights and relatively “standard” moral weights in our analyses going forward.

For more detail, see the full report here.