Incorporating Future Medical Costs: Impact on Cost-Effectiveness Analysis in Cancer Patients
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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.
- 7.Culyer AJ. Cost, context and decisions in health economics and cost-effectiveness analysis. York: University of York; 2018.Google Scholar
- 12.The National Institute for Health and Care Excellence. Guide to the methods of technology appraisal 2013; 2013. https://www.nice.org.uk/process/pmg9/chapter/foreword. Accessed 7 May 2018.
- 13.Pharmaceutical Evaluation Branch DoH. Guidelines for preparing submissions to the Pharmaceutical Benefits Advisory Committee (PBAC); 2017. https://pbac.pbs.gov.au/. Accessed 14 Feb 2018.
- 15.The National Health Care Institute (Zorginstituut Nederland). Guideline for economic evaluations in healthcare; 2016. https://english.zorginstituutnederland.nl/publications/reports/2016/06/16/guideline-for-economic-evaluations-in-healthcare. Accessed 29 Apr 2018.
- 32.Soares M, Welton N, Harrison D, Peura P, Hari M, Harvey S, et al. An evaluation of the feasibility, cost and value of information of a multicentre randomised controlled trial of intravenous immunoglobulin for sepsis (severe sepsis and septic shock): incorporating a systematic review, meta-analysis and value of information analysis. Health Technol Assess. 2012;16:1–186.PubMedPubMedCentralCrossRefGoogle Scholar
- 34.Blakely T, Atkinson J, Kvizhinadze G, Nghiem N, McLeod H, Davies A, et al. Updated New Zealand health system cost estimates from health events by sex, age and proximity to death: further improvements in the age of ‘big data’. NZ Med J. 2015;128(1422):13–23.Google Scholar
- 35.Ministry of Health NZ. Casemix and Diagnosis Related Group (DRG) Allocation—AR-DRG v7.0. 2017. https://www.health.govt.nz/nz-health-statistics/classification-and-terminology/using-icd-10-am-achi-acs/casemix-and-diagnosis-related-group-drg-allocation-ar-drg-v70. Accessed 18 Feb 2019.
- 40.Australian Institute of Health and Welfare. Cancer in Australia 2017. Canberra: AIHW; 2017. https://www.aihw.gov.au/reports/cancer/cancer-in-australia-2017/contents/table-of-contents. Accessed 24 Dec 2017.
- 44.Consumer Price Index, Australia, Dec 2017. [Internet] 2017. http://www.abs.gov.au/ausstats/abs@.nsf/mf/6401.0. Accessed 28 Dec 2017.
- 45.OCED.Stat. Purchasing Power Parities (PPP), data and methodology. [Internet] 2017. https://stats.oecd.org/Index.aspx?DataSetCode=PPPGDP. Accessed 31 Dec 2017.
- 46.Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated health economic evaluation reporting standards (CHEERS)—explanation and elaboration: a report of the ISPOR health economic evaluation publication guidelines good reporting practices task force. Value Health. 2013;16(2):231–50.PubMedCrossRefGoogle Scholar
- 49.Ramos IC, Versteegh MM, de Boer RA, Koenders JM, Linssen GC, Meeder JG, et al. Cost effectiveness of the angiotensin receptor neprilysin inhibitor sacubitril/valsartan for patients with chronic heart failure and reduced ejection fraction in the Netherlands: a country adaptation analysis under the former and current Dutch pharmacoeconomic guidelines. Value Health. 2017;20(10):1260–9.PubMedCrossRefGoogle Scholar
- 68.Australian Institute of Health and Welfare. Health system expenditure on disease and injury in Australia, 2004–05. Canberra: AIHW; 2010. https://www.aihw.gov.au/reports/health-welfare-expenditure/expenditure-disease-injury-2004-05/contents/table-of-contents. Accessed 24 Oct 2018.
- 71.Briggs A, Sculpher M, Claxton K. Decision modelling for health economic evaluation. Oxford: Oxford University Press; 2006.Google Scholar