Ethic and health economic evaluation in the context of decision-making about reimbursement of health technologies by the national health insurance.

Summary Welfare economics encompasses other public choice theories besides utilitarianism, like egalitarian social justice theory. Whether these economic frameworks provide practical tools that could be used in health technology assessment is an ongoing debate, and this study aim to contribute to answer this question. The aim of the first chapter is to review health economic evaluation guidelines and compare methods from three national health technology assessment agencies - NICE (England and Wales), IQWiG (Germany) and KCE (Belgium) - and to assess what social justice principles are implied by their methodological choices. The second chapter studies the moral dilemma raised by adaptive preferences in growth hormones treatment and bilateral cochlear implants. Three options are put forward to solve this dilemma: they are grounded on egalitarian social justice theories. The objective of the third chapter is to provide evidence about the feasibility of assessment based on equivalent income approach, developed by M. Fleurbaey, in the context of public decision making.