Unrelated Medical Costs in Life-Years Gained
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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.
KeywordsEconomic Evaluation Cost Category Healthcare Decision Maker Healthcare Perspective External Consistency
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.
- 1.Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press Inc, 2005Google Scholar
- 2.Gold MR, Siegel JE, Russel LB, et al., editors. Cost-effectiveness in health and medicine. Oxford: Oxford University Press, 1996Google Scholar
- 4.National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: NICE, 2008[online]. Available from URL: http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf [Accessed 2008 Jul 17]
- 7.Brouwer WBF, Rutten FFH, Koopmanschap MA. Costing in economic evaluations. In: Drummond MF, McGuire A, editors. Economic evaluation in health care: merging theory with practice. New York: Oxford University Press, 2001Google Scholar
- 8.Russell LB. Is prevention better than cure? Washington, DC: The Brookings Institution, 1986Google Scholar
- 14.Health Care Insurance Board (CVZ). Guidelines for pharmacoeconomic research, actualized version [in Dutch]. Diemen: Health Care Insurance Board, 2006Google Scholar
- 31.Weinstein MC, Fineberg HV, Elstein AS, et al. Clinical decision analysis. Philadelphia (PA): Saunders, 1980Google Scholar
- 38.Pharmaceutical Benefits Board (LFN). General guidelines for economic evaluations from the Pharmaceutical Benefits Board. Solna: LFN, 2003[online]. Available from URL: http://www.lfn.se/upload/English/ENG_lfnar2003-eng.pdf [Accessed 2008 Jan 18]
- 39.Brouwer WBF, van Exel NJA, van Baal PHM. Costs in life-years gained: is it time for a new guideline? [in Dutch]. VGE-Informatiebulletin 2007; 24 (1): 11–4Google Scholar
- 49.Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation. Cochrane Database Syst Rev 2002: CD000146Google Scholar