Unrelated medical care in life years gained and the cost utility of primary prevention: in search of a 'perfect' cost-utility ratio
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.
Volume (Year): 16 (2007)
Issue (Month): 4 ()
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- Eugene M. Laska & Morris Meisner & Carole Siegel, 1997. "Statistical Inference for Cost-Effectiveness Ratios," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 229-242.
- Maiwenn J. Al & Talitha L. Feenstra & Ben A. van Hout, 2005. "Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty," Health Economics, John Wiley & Sons, Ltd., vol. 14(7), pages 655-667.
- Karlsson, Göran & Johannesson, Magnus, 1998. "Cost-effectiveness analysis and capital costs," Social Science & Medicine, Elsevier, vol. 46(9), pages 1183-1191, May.
- Seshamani, Meena & Gray, Alastair M., 2004. "A longitudinal study of the effects of age and time to death on hospital costs," Journal of Health Economics, Elsevier, vol. 23(2), pages 217-235, March.
- Dorte Gyrd-Hansen & Jes S�ggard & Ole Kronborg, 1998. "Colorectal cancer screening: efficiency and effectiveness," Health Economics, John Wiley & Sons, Ltd., vol. 7(1), pages 9-20.
- Olsen, Jan Abel & Richardson, Jeff, 1999. "Production gains from health care: what should be included in cost-effectiveness analyses?," Social Science & Medicine, Elsevier, vol. 49(1), pages 17-26, July.
- 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.
- Elamin H. Elbasha & Mark L. Messonnier, 2004. "Cost-effectiveness analysis and health care resource allocation: decision rules under variable returns to scale," Health Economics, John Wiley & Sons, Ltd., vol. 13(1), pages 21-35.
- Meltzer, David, 1997. "Accounting for future costs in medical cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 33-64, February.
- Braden Manns & David Meltzer & Ken Taub & Cam Donaldson, 2003. "Illustrating the impact of including future costs in economic evaluations: an application to end-stage renal disease care," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 949-958.
- Birch, Stephen & Gafni, Amiram, 1992. "Cost effectiveness/utility analyses : Do current decision rules lead us to where we want to be?," Journal of Health Economics, Elsevier, vol. 11(3), pages 279-296, October.
- Weinstein, Milton C. & Manning, Willard Jr., 1997. "Theoretical issues in cost-effectiveness analysis," Journal of Health Economics, Elsevier, vol. 16(1), pages 121-128, February.
- Gandjour, Afschin & Lauterbach, Karl Wilhelm, 2005. "Does prevention save costs?: Considering deferral of the expensive last year of life," Journal of Health Economics, Elsevier, vol. 24(4), pages 715-724, July.
- Weinstein, Milton & Zeckhauser, Richard, 1973. "Critical ratios and efficient allocation," Journal of Public Economics, Elsevier, vol. 2(2), pages 147-157, April.
- Raymond C.W. Hutubessy & Rob M.P.M. Baltussen & David B. Evans & Jan J. Barendregt & Christopher J.L. Murray, 2001. "Stochastic league tables: communicating cost-effectiveness results to decision-makers," Health Economics, John Wiley & Sons, Ltd., vol. 10(5), pages 473-477.
- 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.
- David Meltzer, 1997. "Accounting for Future Costs in Medical Cost-Effectiveness Analysis," NBER Working Papers 5946, National Bureau of Economic Research, Inc.
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