de Kok I M C M, Polder J J, Habbema J D F, Berkers L-M, Meerding W J, Rebolj M, van Ballegooijen M
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Br J Cancer. 2009 Apr 21;100(8):1240-4. doi: 10.1038/sj.bjc.6605018.
It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998-1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by 4040 euro in women, and by 4100 euro in men. Of these, 660 euro in women, and 890 euro in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately 4000 euro. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications.
与死亡相关的医疗保健成本以及因挽救生命的干预措施而获得的生命年（LYsG）是否应纳入经济评估，目前仍存在争议。我们估计了纳入这些成本对癌症筛查成本效益的影响。我们获取了1998 - 1999年荷兰210万居民的健康保险、家庭护理、养老院和死亡率数据。与死亡相关的成本通过生命最后一年（LastYL）的医疗保健成本，按死亡原因和年龄进行估算。LYsG中的成本通过计算任何生命年的医疗保健成本来估计。我们计算了如果将LastYL或LYsG中不相关的医疗保健成本纳入，成本效益比（CERs）的变化。死于癌症的人的LastYL平均成本比死于任何原因的人高33%。纳入LYsG中的成本使女性的CER增加了4040欧元，男性增加了4100欧元。其中，女性为660欧元，男性为890欧元，是LastYL中的成本。在LastYL或LYsG中纳入不相关的医疗保健成本将改变医疗保健项目的相对成本效益。癌症筛查项目的CERs将明显增加，约为4000欧元。然而，由于CERs较好，纳入不相关的医疗保健成本通常对政策影响有限。
