title: Accounting for future costs in medical cost-effectiveness analysis.
abstract: Most medical cost-effectiveness analyses include future costs only for related illnesses, but this approach is controversial. This paper demonstrates that cost-effectiveness analysis is consistent with lifetime utility maximization only if it includes all future medical and non-medical expenditures. Estimates of the magnitude of these future costs suggest that they may substantially alter both the absolute and relative cost-effectiveness of medical interventions, particularly when an intervention increases length of life more than quality of life. In older populations, current methods overstate the cost-effectiveness of interventions which extend life compared to interventions which improve the quality of life.
authors.affiliation: University of Chicago and National Bureau of Economic Research, IL 60637, USA. dmeltzer@medicine.bsd.uchicago.edu
authors.forename: D
authors.initials: D
authors.lastname: Meltzer
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000639:trends*; D015276:Health Care Rationing; D006291:Health Policy / Q000191:economics; D006302:Health Services Research / Q000191:economics / Q000379:methods*; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D014481:United States