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PharmacoEconomics

, Volume 26, Issue 10, pp 815–830 | Cite as

Unrelated Medical Costs in Life-Years Gained

Should They be Included in Economic Evaluations of Healthcare Interventions?
  • David R. RappangeEmail author
  • Pieter H. M. van Baal
  • N. Job A. van Exel
  • Talitha L. Feenstra
  • Frans F. H. Rutten
  • Werner B. F. Brouwer
Current Opinion

Abstract

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.

Keywords

Economic Evaluation Cost Category Healthcare Decision Maker Healthcare Perspective External Consistency 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This study was part of the project ‘Living longer in good health’, which was financially supported by Netspar. The opinions expressed in the paper are those of the authors.

The authors have no conflicts of interest that are directly relevant to the content of this article.

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Copyright information

© Adis Data Information BV 2008

Authors and Affiliations

  • David R. Rappange
    • 1
    Email author
  • Pieter H. M. van Baal
    • 1
    • 2
  • N. Job A. van Exel
    • 1
  • Talitha L. Feenstra
    • 2
  • Frans F. H. Rutten
    • 1
  • Werner B. F. Brouwer
    • 1
  1. 1.Department of Health Policy & Management and Institute for Medical Technology AssessmentErasmus University Medical CenterRotterdamthe Netherlands
  2. 2.Centre for Prevention and Health, Services ResearchNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands

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