Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Institute for Medical Technology Assessment(iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Eur J Health Econ. 2023 Jul;24(5):701-715. doi: 10.1007/s10198-022-01501-6. Epub 2022 Aug 4.
When healthcare interventions prolong life, people consume medical and non-medical goods during the years of life they gain. It has been argued that the costs for medical consumption should be included in cost-effectiveness analyses from both a healthcare and societal perspective, and the costs for non-medical consumption should additionally be included when a societal perspective is applied. Standardized estimates of these so-called future costs are available in only a few countries and the impact of inclusion of these costs is likely to differ between countries. In this paper we present and compare future costs for five European countries and estimate the impact of including these costs on the cost-effectiveness of life-prolonging interventions. As countries differ in the availability of data, we illustrate how both individual- and aggregate-level data sources can be used to construct standardized estimates of future costs. Results show a large variation in costs between countries. The medical costs for the Netherlands, Germany, and the United Kingdom are large compared to Spain and Greece. Non-medical costs are higher in Germany, Spain, and the United Kingdom than in Greece. The impact of including future costs on the ICER similarly varied between countries, ranging from €1000 to €35,000 per QALY gained. The variation between countries in impact on the ICER is largest when considering medical costs and indicate differences in both structure and level of healthcare financing in these countries. Case study analyses were performed in which we highlight the large impact of including future costs on ICER relative to willingness-to-pay thresholds.
当医疗干预措施延长生命时，人们会在获得的生命年限内消费医疗和非医疗商品。有人认为，从医疗保健和社会两个角度来看，都应将医疗消费的成本纳入成本效益分析中，而从社会角度来看，还应将非医疗消费的成本纳入其中。这些所谓的未来成本的标准化估计在只有少数几个国家可用，而纳入这些成本的影响可能因国家而异。在本文中，我们介绍并比较了五个欧洲国家的未来成本，并估计了纳入这些成本对延长寿命干预措施的成本效益的影响。由于各国在数据可用性方面存在差异，我们说明了如何使用个人和总体数据源来构建未来成本的标准化估计。结果显示，各国之间的成本存在很大差异。荷兰、德国和英国的医疗成本与西班牙和希腊相比要高得多。德国、西班牙和英国的非医疗成本高于希腊。纳入未来成本对增量成本效益比的影响在各国之间也存在差异，范围从每获得一个质量调整生命年（QALY）的成本效益比 1000 欧元到 35000 欧元不等。考虑到医疗成本，国家之间对增量成本效益比的影响差异最大，表明这些国家在医疗保健结构和水平方面存在差异。我们进行了案例研究分析，强调了纳入未来成本对 ICER 的影响相对意愿支付阈值的巨大影响。
