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Context-Specific Estimation of Future Unrelated Medical Costs and Their Impact on Cost-Effectiveness Analyses

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Abstract

Objectives

This study constructed and applied procedures for the estimation of unrelated future medical costs (UFMC) of women with breast cancer in Israel (as a case study) and examined the influence of including UFMC in cost-effectiveness analyses (CEAs).

Methods

Part I consisted of a retrospective cohort study based on patient-level claims data of both patients with breast cancer and matched controls during 14 years of follow-up. UFMC were estimated as (a) the annual average all-cause healthcare costs of the control subjects, and (b) as predicted values based on a generalized linear model (GLM) adjusted to patients’ characteristics. Part II consisted of a CEA performed using a Markov simulation model comparing regimens of chemotherapy with/without trastuzumab, both excluding and including UFMC and for each of the UFMC estimates separately. All costs were adjusted to 2019 prices. Costs and QALYs were discounted at a yearly rate of 3%.

Results

The average annual healthcare costs in the control group were $2328 (± $5662). The corresponding incremental cost-effectiveness ratio (ICER) was $53,411/QALY and $55,903/QALY, when UFMC were excluded or included, respectively. Hence, trastuzumab was not considered cost-effective compared with a threshold of willingness-to-pay of $37,000 per QALY, regardless of the inclusion of UFMC. When UFMC were estimated on the basis of the prediction model, the ICERs were $37,968/QALY and $39,033/QALY, when UFMC were excluded or included, respectively. Thus, in this simulation, trastuzumab was not considered cost-effective, independent of the inclusion of UFMC.

Conclusion

Our case study revealed that the inclusion of UFMC had modest effect on the ICERs, and thus did not alter the conclusion. Thus, we should estimate context-specific UFMC if they are expected to change the ICERs significantly, and transparently report the corresponding assumptions to uphold the integrity and reliability of the economic evaluation.

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Acknowledgements

Without implicating him in any remaining flaws and errors, we thank Dr. Daniel Goldstein for his contribution in the initial stages of the design process.

Author information

Authors and Affiliations

  1. Department of Industrial Engineering and Management, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

    Noga Epstein & Yakir Berchenko

  2. Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O Box 653, 8410501, Beer-Sheva, Israel

    Tzahit Simon-Tuval

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  1. Noga Epstein
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Corresponding author

Correspondence to Tzahit Simon-Tuval.

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Funding

This study was funded by the Israel National Institute for Health Policy Research (grant no. R/2018/275). The funder has no role in the identification, design, conduct, and reporting of the analysis. There were no other non-monetary sources of support.

Competing Interests

The authors have no financial or non-financial competing interests to declare.

Ethics Approval

Part I of the study was approved by Clalit Health Services Helsinki Committee (0200-19-COM2), and participants’ informed consent was waived by this committee since this was a secondary analysis of a deidentified dataset. Part II of the study did not require ethics approval.

Consent to Participate

Consent to participate was not required for this study.

Consent for Publication

Consent to publish was not required for this study.

Data Availability

The data that support the findings of this study contain potentially identifiable patient information. Thus, following the requirements of Clalit Health Services Helsinki Committee, the data are not publicly available. Data requests may be sent to the corresponding author (TST).

Code availability

R code will be available upon request.

Author Contributions

NE, TST, and YB were involved in the conception and design of the study, TST and YB were responsible of obtaining the data for analysis. NE, TST, and YB analyzed and interpreted the data. NE drafted the manuscript. All authors reviewed the manuscript and approved the final draft.

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Epstein, N., Simon-Tuval, T. & Berchenko, Y. Context-Specific Estimation of Future Unrelated Medical Costs and Their Impact on Cost-Effectiveness Analyses. PharmacoEconomics 41, 1275–1286 (2023). https://doi.org/10.1007/s40273-023-01290-7

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