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Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a 'perfect' cost-utility ratio

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  • Pieter H. M. van Baal

    (Centre for Prevention and Health Services Research (PZO), National Institute for Public Health and the Environment (RIVM), The Netherlands)

  • Talitha L. Feenstra

    (Centre for Prevention and Health Services Research (PZO), National Institute for Public Health and the Environment (RIVM), The Netherlands)

  • Rudolf T. Hoogenveen

    (Centre for Prevention and Health Services Research (PZO), National Institute for Public Health and the Environment (RIVM), The Netherlands)

  • G. Ardine de Wit

    (Centre for Prevention and Health Services Research (PZO), National Institute for Public Health and the Environment (RIVM), The Netherlands)

  • Werner B. F. Brouwer

    (Institute for Medical Technology Assessment, Erasmus Medical Center, Rotterdam, The Netherlands)

Abstract

An important subject of debate in cost-utility analysis of health care programmes is whether to include costs of unrelated medical care in life years gained. The inclusion of such costs is likely to be of consequence in the case of primary prevention. This paper presents different strategies regarding the inclusion not only of the costs, but also of the health effects of unrelated medical care in economic evaluations. Four different cost-utility ratios are presented and related to the criterion of internal consistency. In addition, the possibility to relate the ratios to a well-posed decision problem is analysed. An example computes the different ratios for smoking cessation interventions in different age groups. Including health care costs of unrelated medical care in life years gained increases cost utility ratios, but excluding unrelated medical costs favours smoking cessation interventions targeted at older smokers over those at younger smokers. We conclude that for primary prevention only a cost utility ratio that includes both the costs and effects of unrelated medical care meets the criterion of internal consistency and is related to a meaningful decision problem. Therefore, this type of cost-utility ratio should be preferred even if the data requirements may be substantial. Copyright © 2006 John Wiley & Sons, Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:16:y:2007:i:4:p:421-433
    DOI: 10.1002/hec.1181
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    References listed on IDEAS

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    Cited by:

    1. Dieter Tscheulin & Florian Drevs, 2010. "The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(2), pages 141-150, April.
    2. Pieter H. M. van Baal & Talitha L. Feenstra & Johan J. Polder & Rudolf T. Hoogenveen & Werner B. F. Brouwer, 2011. "Economic evaluation and the postponement of health care costs," Health Economics, John Wiley & Sons, Ltd., vol. 20(4), pages 432-445, April.
    3. Kanters, Tim A. & Brouwer, Werner B.F. & van Vliet, René C.J.A. & van Baal, Pieter H.M. & Polder, Johan J., 2013. "A new prevention paradox: The trade-off between reducing incentives for risk selection and increasing the incentives for prevention for health insurers," Social Science & Medicine, Elsevier, vol. 76(C), pages 150-158.
    4. Feenstra, T.L. & van Baal, P.M. & Jacobs-van der Bruggen, M.A.M. & Hoogenveen, R.T. & Kommer, G.J. & Baan, C.A., 2011. "Targeted versus universal prevention. A resource allocation model to prioritize cardiovascular prevention," Other publications TiSEM da2bcf9c-cba4-4f97-86bf-a, Tilburg University, School of Economics and Management.
    5. Bengt Liljas, 2010. "On the welfare theoretic foundation of cost-effectiveness analysis—the case when survival is not affected," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(1), pages 5-13, February.
    6. Afschin Gandjour & Dirk Müller, 2014. "Ethical Objections Against Including Life-Extension Costs in Cost-Effectiveness Analysis: A Consistent Approach," Applied Health Economics and Health Policy, Springer, vol. 12(5), pages 471-476, October.
    7. Vandoros, Sotiris & Carman, Katherine Grace, 2011. "Demand and pricing of preventative healthcare," LSE Research Online Documents on Economics 37159, London School of Economics and Political Science, LSE Library.

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