Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
National Centre for Infections in Cancer, Peter MacCallum Cancer Institute, Melbourne, Australia.
Pharmacoeconomics. 2019 Jul;37(7):931-941. doi: 10.1007/s40273-019-00790-9.
The inclusion of future medical costs in cost-effectiveness analyses remains a controversial issue. The impact of capturing future medical costs is likely to be particularly important in patients with cancer where costly lifelong medical care is necessary. The lack of clear, definitive pharmacoeconomic guidelines can limit comparability and has implications for decision making.
The aim of this study was to demonstrate the impact of incorporating future medical costs through an applied example using original data from a clinical study evaluating the cost effectiveness of a sepsis intervention in cancer patients.
A decision analytic model was used to capture quality-adjusted life-years (QALYs) and lifetime costs of cancer patients from an Australian healthcare system perspective over a lifetime horizon. The evaluation considered three scenarios: (1) intervention-related costs (no future medical cost), (2) lifetime cancer costs and (3) all future healthcare costs. Inputs to the model included patient-level data from the clinical study, relative risk of death due to sepsis, cancer mortality and future medical costs sourced from published literature. All costs are expressed in 2017 Australian dollars and discounted at 5%. To further assess the impact of future costs on cancer heterogeneity, variation in survival and lifetime costs between cancer types and the implications for cost-effectiveness analysis were explored.
The inclusion of future medical costs increased incremental cost-effectiveness ratios (ICERs) resulting in a shift from the intervention being a dominant strategy (cheaper and more effective) to an ICER of $7526/QALY. Across different cancer types, longer life expectancies did not necessarily result in greater lifetime healthcare costs. Incremental costs differed across cancers depending on the respective costs of managing cancer and survivorship, thus resulting in variations in ICERs.
There is scope for including costs beyond intervention costs in economic evaluations. The inclusion of future medical costs can result in markedly different cost-effectiveness results, leading to higher ICERs in a cancer population, with possible implications for funding decisions.
将未来医疗成本纳入成本效益分析仍然存在争议。在需要昂贵终身医疗护理的癌症患者中，捕捉未来医疗成本的影响可能尤为重要。缺乏明确、明确的药物经济学指南会限制可比性，并对决策产生影响。
本研究旨在通过使用评估癌症患者脓毒症干预成本效益的临床研究的原始数据进行应用示例，展示纳入未来医疗成本的影响。
使用决策分析模型从澳大利亚医疗保健系统的角度捕获癌症患者的质量调整生命年（QALYs）和终生成本。该评估考虑了三种情况：（1）干预相关成本（无未来医疗成本），（2）终生癌症成本和（3）所有未来医疗保健成本。模型的输入包括来自临床研究的患者水平数据、因脓毒症导致死亡的相对风险、癌症死亡率和来自已发表文献的未来医疗成本。所有成本均以 2017 年澳元表示，并贴现 5%。为了进一步评估未来成本对癌症异质性、不同癌症类型之间的生存和终生成本的影响以及对成本效益分析的影响，进行了探讨。
纳入未来医疗成本增加了增量成本效益比（ICERs），导致干预成为主导策略（更便宜且更有效）的情况发生变化，ICER 为 7526 澳元/QALY。在不同的癌症类型中，寿命预期的增加不一定会导致更大的终生医疗保健成本。增量成本因管理癌症和生存成本的各自成本而异，因此导致 ICER 有所不同。
在经济评估中纳入干预成本以外的成本是有意义的。纳入未来医疗成本可能会导致成本效益结果明显不同，导致癌症人群中的 ICER 更高，这可能对资金决策产生影响。
