van Baal Pieter, Meltzer David, Brouwer Werner
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
University of Chicago, Chicago, IL, USA.
Health Econ. 2016 Feb;25(2):237-48. doi: 10.1002/hec.3138. Epub 2014 Dec 23.
Life-saving medical technologies result in additional demand for health care due to increased life expectancy. However, most economic evaluations do not include all medical costs that may result from this additional demand in health care and include only future costs of related illnesses. Although there has been much debate regarding the question to which extent future costs should be included from a societal perspective, the appropriate role of future medical costs in the widely adopted but more narrow healthcare perspective has been neglected. Using a theoretical model, we demonstrate that optimal decision rules for cost-effectiveness analyses assuming fixed healthcare budgets dictate that future costs of both related and unrelated medical care should be included. Practical relevance of including the costs of future unrelated medical care is illustrated using the example of transcatheter aortic valve implantation. Our findings suggest that guidelines should prescribe inclusion of these costs.
由于预期寿命延长，救生医疗技术导致了对医疗保健的额外需求。然而，大多数经济评估并未涵盖因这种医疗保健额外需求可能产生的所有医疗成本，而仅包括相关疾病的未来成本。尽管从社会角度来看，关于应在多大程度上纳入未来成本存在诸多争论，但在广泛采用但更为狭义的医疗保健视角下，未来医疗成本的适当作用却被忽视了。通过一个理论模型，我们证明，在假定医疗保健预算固定的情况下，成本效益分析的最优决策规则要求应纳入相关和不相关医疗护理的未来成本。以经导管主动脉瓣植入术为例说明了纳入未来不相关医疗护理成本的实际意义。我们的研究结果表明，指南应规定纳入这些成本。
