Unrelated medical costs in life-years gained: should they be included in economic evaluations of healthcare interventions?
Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the analysis. National guidelines for pharmacoeconomic research largely endorse this practice, either by explicitly requiring researchers to exclude these costs from the analysis or by leaving inclusion or exclusion up to the discretion of the analyst. However, the inclusion of unrelated medical costs in life-years gained appears to be gaining support in the literature.This article provides an overview of the discussions to date. The inclusion of unrelated medical costs in life-years gained seems warranted, in terms of both optimality and internal and external consistency. We use an example of a smoking-cessation intervention to highlight the consequences of different practices of accounting for costs and effects in economic evaluations. Only inclusion of all costs and effects of unrelated medical care in life-years gained can be considered both internally and externally consistent. Including or excluding unrelated future medical costs may have important distributional consequences, especially for interventions that substantially increase length of life. Regarding practical objections against inclusion of future costs, it is important to note that it is becoming increasingly possible to accurately estimate unrelated medical costs in life-years gained. We therefore conclude that the inclusion of unrelated medical costs should become the new standard.
Rappange
David R
DR
Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Medical Center, Rotterdam, the Netherlands. d.rappange@erasmusmc.nl
van Baal
Pieter H M
PH
van Exel
N Job A
NJ
Feenstra
Talitha L
TL
Rutten
Frans F H
FF
Brouwer
Werner B F
WB
D017850:Economics, Pharmaceutical; D017408:Guidelines as Topic; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D012107:Research Design
Health Policy. 2002 Aug;61(2):173-87
12088890
Health Econ. 2007 Apr;16(4):421-33
17039573
Cochrane Database Syst Rev. 2002;(4):CD000146
12519537
Diabetologia. 2005 May;48(5):868-77
15834550
Health Econ. 2006 Mar;15(3):315-7; discussion 319-22
16444762
Health Econ. 2006 Mar;15(3):311-3; discussion 319-22
16389655
Med Decis Making. 1999 Oct-Dec;19(4):371-7
10520672
Health Econ. 1999 Sep;8(6):485-96
10544314
Health Econ. 1998 Feb;7(1):1-7
9541079
Health Policy. 2002 Nov;62(2):161-72
12354410
Health Policy. 1995 Jul;33(1):59-66
10143700
J Health Econ. 1995 Jun;14(2):171-89
10154656
Value Health. 2005 May-Jun;8(3):178-90
15877590
J Health Econ. 2000 Jul;19(4):439-59
11010234
J Health Econ. 2005 Jul;24(4):715-24
15960993
PLoS Med. 2008 Feb;5(2):e29
18254654
Cancer. 1992 Apr 1;69(7 Suppl):1957-62
1544100
Health Econ. 1998 Feb;7(1):9-20
9541080
Med Decis Making. 1999 Oct-Dec;19(4):378-9; discussion 383-4
10520673
J Health Econ. 1997 Apr;16(2):249-55; discussion 257-9
10173080
J Health Econ. 1997 Feb;16(1):1-31
10167341
Health Econ. 1997 Sep-Oct;6(5):511-4
9353652
Health Econ. 2007 Oct;16(10):1109-26
17311357
Health Econ. 2008 May;17(5):579-91
17787027
Addiction. 2005 Apr;100 Suppl 2:70-83
15844290
Pharmacoeconomics. 1998 May;13(5 Pt 1):563-9
10180754
Health Econ. 2003 Nov;12(11):949-58
14601157
Value Health. 2006 Sep-Oct;9(5):341-7
16961552
J Health Econ. 1997 Feb;16(1):121-8
10167343
Pharmacoeconomics. 2005;23(2):105-11
15748085
J Health Econ. 2008 Jul;27(4):809-818
18201785
J Health Econ. 2008 Jul;27(4):819-21
18539348
J Health Econ. 2002 Jan;21(1):169-75; discussion 177-8
11845923
Age Ageing. 2004 Nov;33(6):556-61
15308460
Int J Technol Assess Health Care. 2000 Winter;16(1):111-24
10815358
Health Econ. 1997 Sep-Oct;6(5):505-10
9353651
J Health Econ. 2008 Mar;27(2):325-38
18179835
J Health Econ. 1997 Feb;16(1):33-64
10167344
Health Econ. 2004 May;13(5):417-27
15127422
Health Econ. 2008 Feb;17(2):293-7
17891823
J Health Econ. 2008 Jul;27(4):822-825
18534699
Health Econ. 1997 May-Jun;6(3):253-9
9226143