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Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018

Author

Listed:
  • David D. Kim

    (Tufts Medical Center
    Tufts University School of Medicine)

  • Madison C. Silver

    (Tufts Medical Center)

  • Natalia Kunst

    (University of Oslo
    Yale University School of Medicine
    LINK Medical Research)

  • Joshua T. Cohen

    (Tufts Medical Center
    Tufts University School of Medicine)

  • Daniel A. Ollendorf

    (Tufts Medical Center
    Tufts University School of Medicine)

  • Peter J. Neumann

    (Tufts Medical Center
    Tufts University School of Medicine)

Abstract

Objective Our objective was to examine perspective and costing approaches used in cost-effectiveness analyses (CEAs) and the distribution of reported incremental cost-effectiveness ratios (ICERs). Methods We analyzed the Tufts Medical Center’s CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. We examined how often published CEAs included non-health consequences and their impact on ICERs. We also reviewed 45 country-specific guidelines to examine recommended analytic perspectives. Results Study authors often mis-specified or did not clearly state the perspective used. After re-classification by registry reviewers, a healthcare sector or payer perspective was most prevalent (74%). CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence included was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). Of 19,946 cost-per-QALY ratios, the median ICER was $US26,000/QALY (interquartile range [IQR] 2900–110,000), and 18% were cost saving and QALY increasing. Of 5572 cost-per-DALY ratios, the median ICER was $US430/DALY (IQR 67–3400), and 8% were cost saving and DALY averting. Based on 16 cost-per-QALY studies (2017–2018) reporting 68 ICERs from both the healthcare sector and societal perspectives, the median ICER from a societal perspective ($US22,710/QALY [IQR 11,991–49,603]) was more favorable than from a healthcare sector perspective ($US30,402/QALY [IQR 10,486–77,179]). Most governmental guidelines (67%) recommended either a healthcare sector or a payer perspective. Conclusion Researchers should justify and be transparent about their choice of perspective and costing approaches. The use of the impact inventory and reporting of disaggregate outcomes can reduce inconsistencies and confusion.

Suggested Citation

  • David D. Kim & Madison C. Silver & Natalia Kunst & Joshua T. Cohen & Daniel A. Ollendorf & Peter J. Neumann, 2020. "Perspective and Costing in Cost-Effectiveness Analysis, 1974–2018," PharmacoEconomics, Springer, vol. 38(10), pages 1135-1145, October.
  • Handle: RePEc:spr:pharme:v:38:y:2020:i:10:d:10.1007_s40273-020-00942-2
    DOI: 10.1007/s40273-020-00942-2
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    References listed on IDEAS

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    1. Werner B.F. Brouwer & Marc A. Koopmanschap & Frans F.H. Rutten, 1997. "Productivity costs in cost‐effectiveness analysis: numerator or denominator: a further discussion," Health Economics, John Wiley & Sons, Ltd., vol. 6(5), pages 511-514, September.
    2. John A. Nyman, 2004. "Should the consumption of survivors be included as a cost in cost–utility analysis?," Health Economics, John Wiley & Sons, Ltd., vol. 13(5), pages 417-427, May.
    3. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
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    1. Chris Sampson’s journal round-up for 12th October 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-10-12 11:00:03

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