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Should the consumption of survivors be included as a cost in cost-utility analysis?

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Author Info
John A. Nyman (University of Minnesota, Minneapolis, USA)

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Abstract

Survivor costs are those costs associated with a treatment because it extends the patient's life. A controversy exists regarding whether survivor consumption costs should be included in cost-utility analyses. The present paper uses this controversy to motivate a general reexamination of what costs to include in cost-utility analyses. Rather than the ad hoc inclusion rules currently used - a causal relationship between the intervention and the costs, and a proscription on double counting - this paper suggests three inclusion principles based on standard welfare economics. Thus, costs should be (1) included if they represent resources that directly produce the utility that is being measured in the denominator of the cost-utility ratio, (2) excluded if they represent resources that produce utility that is not being measured in the denominator, even though the costs are causally associated with the intervention, and (3) included if they represent resources consumed that are causally related to the intervention, but that have no counterveiling utility gains. These principles suggest important changes in how we account for recuperation time and unrelated medical care. They also suggest that survival consumption costs and earnings be excluded from existing cost-utility analyses. Copyright © 2003 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.850
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Publisher Info
Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 13 (2004)
Issue (Month): 5 ()
Pages: 417-427
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Handle: RePEc:wly:hlthec:v:13:y:2004:i:5:p:417-427

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References listed on IDEAS
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
  1. Mike Drummond & Alastair McGuire & Astrid Fletcher, 1993. "Economic evaluation of drug therapy for hypercholesterolaemia in the United Kingdom," Working Papers 104chedp, Centre for Health Economics, University of York. [Downloadable!]
  2. David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc. [Downloadable!] (restricted)
  3. Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February. [Downloadable!] (restricted)
  4. Garber, Alan M. & Phelps, Charles E., 1997. "Economic foundations of cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 1-31, February. [Downloadable!] (restricted)
  5. Amartya Sen, 1999. "The Possibility of Social Choice," American Economic Review, American Economic Association, vol. 89(3), pages 349-378, June. [Downloadable!] (restricted)
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Cited by:
(explanations, Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.)

  1. Pieter H. M. van Baal & Talitha L. Feenstra & Rudolf T. Hoogenveen & G. Ardine de Wit & Werner B. F. Brouwer, 2007. "Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a 'perfect' cost-utility ratio," Health Economics, John Wiley & Sons, Ltd., vol. 16(4), pages 421-433. [Downloadable!]
  2. Douglas Lundin & Joakim Ramsberg, 2008. "On survival consumption costs - a reply to Nyman," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 293-297. [Downloadable!]
  3. Afschin Gandjour, 2009. "Aging diseases - do they prevent preventive health care from saving costs?," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 355-362. [Downloadable!]
  4. Liqun Liu & Andrew J. Rettenmaier & Thomas R. Saving, 2008. "Longevity bias in cost-effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 17(4), pages 523-534. [Downloadable!]
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