Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients
The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making.
The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients.
A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored.
The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs.
There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
The authors would like to acknowledge and thank Professor Tony Blakely for his helpful comments and input into an earlier version of the paper.
All authors contributed to the conception and planning of the work. Michelle Tew developed the cost-effectiveness model and conducted the analyses with input from Kim Dalziel and Philip Clarke. Karin Thursky led the clinical study and provided clinical evidence input and resource use data to estimate costs of the intervention. Michelle Tew led the writing of this manuscript and was supervised by all authors. All authors participated in the discussion that led to this paper and in the revision of all drafts. All authors approved the final version submitted for publication.
This study was supported by the Australian National Health and Medical Research Council (NHMRC)-funded Centre for Improving Cancer Outcomes Through Enhanced Infection Services (1116876). Michelle Tew is jointly supported by the NHMRC-funded Centre for Research Excellence in Total Joint Replacement (1116325) and Centre for Improving Cancer Outcomes Through Enhanced Infection Services (1116876), and a Melbourne Research Scholarship.
Compliance with Ethical Standards
Conflict of interest
Michelle Tew, Philip Clarke, Karin Thursky and Kim Dalziel have no conflicts of interest that are directly relevant to the contents of this article.
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