Rappange David R, van Baal Pieter H M, van Exel N Job A, Feenstra Talitha L, Rutten Frans F H, Brouwer Werner B F
Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Medical Center, Rotterdam, the Netherlands.
Pharmacoeconomics. 2008;26(10):815-30. doi: 10.2165/00019053-200826100-00003.
Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the analysis. National guidelines for pharmacoeconomic research largely endorse this practice, either by explicitly requiring researchers to exclude these costs from the analysis or by leaving inclusion or exclusion up to the discretion of the analyst. However, the inclusion of unrelated medical costs in life-years gained appears to be gaining support in the literature.This article provides an overview of the discussions to date. The inclusion of unrelated medical costs in life-years gained seems warranted, in terms of both optimality and internal and external consistency. We use an example of a smoking-cessation intervention to highlight the consequences of different practices of accounting for costs and effects in economic evaluations. Only inclusion of all costs and effects of unrelated medical care in life-years gained can be considered both internally and externally consistent. Including or excluding unrelated future medical costs may have important distributional consequences, especially for interventions that substantially increase length of life. Regarding practical objections against inclusion of future costs, it is important to note that it is becoming increasingly possible to accurately estimate unrelated medical costs in life-years gained. We therefore conclude that the inclusion of unrelated medical costs should become the new standard.
在医疗保健干预措施的经济评估中应考虑哪些成本和收益，仍然是一个备受争议的领域。与生命年收益无关的医疗成本是一个重要的成本类别，在经济评估中通常被忽视，无论选择何种分析视角。国家药物经济学研究指南在很大程度上支持这种做法，要么明确要求研究人员在分析中排除这些成本，要么将其纳入或排除交由分析师自行决定。然而，将与生命年收益无关的医疗成本纳入其中在文献中似乎正获得支持。本文概述了迄今为止的相关讨论。从最优性以及内部和外部一致性来看，将与生命年收益无关的医疗成本纳入其中似乎是合理的。我们以戒烟干预措施为例，来突出经济评估中不同成本和效果核算方法的后果。只有将与生命年收益无关的医疗护理的所有成本和效果都纳入其中，才可以被认为在内部和外部都是一致的。纳入或排除未来与生命年收益无关的医疗成本可能会产生重要的分配后果，尤其是对于那些大幅延长寿命的干预措施。关于反对纳入未来成本的实际异议，需要注意的是，准确估计与生命年收益无关的医疗成本变得越来越可行。因此，我们得出结论，纳入与生命年收益无关的医疗成本应成为新的标准。
