IDEAS home Printed from https://ideas.repec.org/a/spr/pharme/v38y2020i10d10.1007_s40273-020-00942-2.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40273-020-00942-2
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40273-020-00942-2?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. 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.
    2. 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.
    3. 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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    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

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Alec Morton & Amanda I. Adler & David Bell & Andrew Briggs & Werner Brouwer & Karl Claxton & Neil Craig & Alastair Fischer & Peter McGregor & Pieter van Baal, 2016. "Unrelated Future Costs and Unrelated Future Benefits: Reflections on NICE Guide to the Methods of Technology Appraisal," Health Economics, John Wiley & Sons, Ltd., vol. 25(8), pages 933-938, August.
    2. Peter J. Neumann & David D. Kim & Thomas A. Trikalinos & Mark J. Sculpher & Joshua A. Salomon & Lisa A. Prosser & Douglas K. Owens & David O. Meltzer & Karen M. Kuntz & Murray Krahn & David Feeny & An, 2018. "Future Directions for Cost-effectiveness Analyses in Health and Medicine," Medical Decision Making, , vol. 38(7), pages 767-777, October.
    3. Linda M. Vries & Pieter H. M. Baal & Werner B. F. Brouwer, 2019. "Future Costs in Cost-Effectiveness Analyses: Past, Present, Future," PharmacoEconomics, Springer, vol. 37(2), pages 119-130, February.
    4. Irina Pokhilenko & Luca M. M. Janssen & Aggie T. G. Paulus & Ruben M. W. A. Drost & William Hollingworth & Joanna C. Thorn & Sian Noble & Judit Simon & Claudia Fischer & Susanne Mayer & Luis Salvador-, 2023. "Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM," Applied Health Economics and Health Policy, Springer, vol. 21(2), pages 155-166, March.
    5. Chiranjeev Sanyal & Don Husereau, 2020. "Systematic Review of Economic Evaluations of Services Provided by Community Pharmacists," Applied Health Economics and Health Policy, Springer, vol. 18(3), pages 375-392, June.
    6. 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, April.
    7. Bengt Liljas, 2011. "Welfare, QALYs, and costs – a comment," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 68-72, January.
    8. 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, February.
    9. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    10. Christopher M Doran & Irina Kinchin, 2020. "Economic and epidemiological impact of youth suicide in countries with the highest human development index," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-11, May.
    11. Boniface Oyugi & Olena Nizalova & Sally Kendall & Stephen Peckham, 2024. "Does a free maternity policy in Kenya work? Impact and cost–benefit consideration based on demographic health survey data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(1), pages 77-89, February.
    12. Muchandifunga Trust Muchadeyi & Karla Hernandez-Villafuerte & Gian Luca Tanna & Rachel D. Eckford & Yan Feng & Michela Meregaglia & Tessa Peasgood & Stavros Petrou & Jasper Ubels & Michael Schlander, 2024. "Quality Appraisal in Systematic Literature Reviews of Studies Eliciting Health State Utility Values: Conceptual Considerations," PharmacoEconomics, Springer, vol. 42(7), pages 767-782, July.
    13. Lili Wang & Lei Si & Fiona Cocker & Andrew J. Palmer & Kristy Sanderson, 2018. "A Systematic Review of Cost-of-Illness Studies of Multimorbidity," Applied Health Economics and Health Policy, Springer, vol. 16(1), pages 15-29, February.
    14. Etienne Nédellec & Judith Pineau & Patrice Prognon & Nicolas Martelli, 2018. "Level of Evidence in Economic Evaluations of Left Atrial Appendage Closure Devices: A Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 16(6), pages 793-802, December.
    15. Qi Cao & Erik Buskens & Hans L. Hillege & Tiny Jaarsma & Maarten Postma & Douwe Postmus, 2019. "Stratified treatment recommendation or one-size-fits-all? A health economic insight based on graphical exploration," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 475-482, April.
    16. Tilling, C & Krol, M & Tsuchiya, A & Brazier, J & van Exel, J & Brouwer, W, 2009. "The impact of losses in income due to ill health: does the EQ-5D reflect lost earnings?," MPRA Paper 29837, University Library of Munich, Germany.
    17. Hensher, Martin & Canny, Ben & Zimitat, Craig & Campbell, Julie & Palmer, Andrew, 2020. "Health care, overconsumption and uneconomic growth: A conceptual framework," Social Science & Medicine, Elsevier, vol. 266(C).
    18. Dongzhe Hong & Lei Si & Minghuan Jiang & Hui Shao & Wai-kit Ming & Yingnan Zhao & Yan Li & Lizheng Shi, 2019. "Cost Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors, Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists, and Dipeptidyl Peptidase-4 (DPP-4) Inhibitors: A Systematic Review," PharmacoEconomics, Springer, vol. 37(6), pages 777-818, June.
    19. Werner Brouwer & Kaya Verbooy & Renske Hoefman & Job Exel, 2023. "Production Losses due to Absenteeism and Presenteeism: The Influence of Compensation Mechanisms and Multiplier Effects," PharmacoEconomics, Springer, vol. 41(9), pages 1103-1115, September.
    20. Simon Pol & Paula Rojas Garcia & Fernando Antoñanzas Villar & Maarten J. Postma & Antoinette D. I. Asselt, 2021. "Health-Economic Analyses of Diagnostics: Guidance on Design and Reporting," PharmacoEconomics, Springer, vol. 39(12), pages 1355-1363, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:pharme:v:38:y:2020:i:10:d:10.1007_s40273-020-00942-2. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.