Journal Article

Unrelated Medical Costs in Life-Years Gained

Rappange, David R., van Baal, Pieter H. M., Rutten, Frans F. H., Feenstra, Talitha L., van Exel, N. Job A., Brouwer, Werner B. F.

2008

Overview

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.

• Publisher: Springer International Publishing,Adis International,Springer Healthcare | Adis,Springer,Springer Nature B.V
• Subject: Analysis. Health state / Biological and medical sciences / Cost analysis / Cost control / Current Opinion / Decision making / Economic-implications / Economics, Pharmaceutical / Epidemiology / General aspects / Guidelines as Topic / Health Administration / Health Care Costs - statistics & numerical data / Health care expenditures / Health Economics / Health-policy / Heart surgery / Humans / Indirect-costs / Intervention / Life Expectancy / Medical sciences / Medicine / Medicine & Public Health / Models, Economic / Pharmacoeconomics / Pharmacoeconomics and Health Outcomes / Pharmacology / Public Health / Public health. Hygiene / Public health. Hygiene-occupational medicine / Quality of Life Research / Quality-Adjusted Life Years / Research Design / Studies