Future costs in cost-effectiveness analysis: an empirical assessment.
European Journal of Health Economy 2010 Sep 28
AIM: The aim of this study was to assess the impact on the
cost-effectiveness ratio of including measures of production and
consumption following a health care or health promotion intervention
that improves survival.
DATA AND METHODS: We defined the net incremental consumption, or future
costs, as the change in consumption minus change in production, while
differentiating between health care and non-health care consumption.
Based on 2005 register-based data for the entire Danish population, we
estimated the average value of annual production and consumption for
1-year age groups. We computed the net consumption in the remaining
expected lifetime and the net consumption per life year gained for
different age groups.
RESULTS: Age has a profound effect on the magnitude of net consumption.
When including net incremental consumption in the cost-effectiveness
ratio of a health care or health promotion intervention, the relative
cost-effectiveness changed up to <euro>21,000 across age groups.
The largest difference in the cost-effectiveness ratio was observed
among the 30-year-olds where costs were reduced significantly due to
significant future net contributions to society.
CONCLUSION: This paper contains cost figures for use in
cost-effectiveness analyses, when the societal perspective is adopted
and future consumption and production effects are taken into account.
The net consumption varies considerably with age. Inclusion of net
incremental consumption in the cost-effectiveness analysis will
markedly affect the relative cost-effectiveness of interventions
targeted at different age groups. Omitting future cost from
cost-effectiveness analysis may bias the ranking of health care
interventions and favour interventions aimed at older age groups. We
used Danish data for this assessment, and our results will therefore
not represent true figures for other countries. We do, however, believe
that the overall impact of including net production value in CEA will
be similar in other countries that have similar transfers of income
from the younger age groups to older age groups as well as publicly
financed social and health care services.
PMID: 20878202 [PubMed - as supplied by publisher]