The Comparative Health Outcomes, Policy, Economics (CHOICE) Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357631 H375Q, Seattle, WA, USA.
Pharmacoeconomics. 2023 Sep;41(9):1065-1077. doi: 10.1007/s40273-023-01246-x. Epub 2023 Mar 6.
The Second Panel on Cost Effectiveness in Health and Medicine recommended that cost-effectiveness analyses (CEA) explicitly incorporate the valuation of productive time from a societal perspective. We developed a new approach to capture productivity impacts in CEA without direct evidence on these impacts by associating varying levels of health-related quality-of-life (HrQoL) score with different time uses in the United States.
We conceptualized a framework that estimates the association between HrQoL score with productivity through time uses. We used the American Time-Use Survey (ATUS) from year 2012-2013, when data on a Well-Being Module (WBM) was additionally collected alongside ATUS. The WBM measured the quality of life (QoL) score using a visual analog scale. To operationalize our conceptual framework, we employed an econometric approach that addressed three technical issues in the observed data: (i) distinction between overall QoL and HrQoL, (ii) correlation across different categories of time use and the share structure of time-use data, and (iii) reverse causality between time uses and HrQoL score in a cross-sectional setting. Furthermore, we developed a metamodel-based algorithm to summarize the numerous estimates from the primary econometric model efficiently. Finally, we illustrated the use of our algorithm to calculate productivity and time spent seeking care costs in an empirical CEA of a prostate cancer treatment.
We provide the estimates of the metamodel algorithm. Incorporating these estimates into the empirical CEA reduced the incremental cost-effectiveness ratio by 27%.
Our estimates can facilitate the inclusion of productivity and time spent seeking care in CEA as recommended by the Second Panel.
第二健康与医疗成本效益专家组建议，成本效益分析（CEA）应明确纳入从社会角度对生产性时间的估值。我们开发了一种新方法，通过将不同水平的健康相关生活质量（HrQoL）评分与美国不同的时间用途相关联，在没有这些影响的直接证据的情况下，在 CEA 中捕捉生产力影响。
我们构建了一个框架，该框架通过时间用途估计 HrQoL 评分与生产力之间的关联。我们使用了 2012-2013 年的美国时间使用调查（ATUS），当时还额外收集了 ATUS 旁边的幸福感模块（WBM）的数据。WBM 使用视觉模拟量表测量生活质量（QoL）评分。为了实现我们的概念框架，我们采用了计量经济学方法来解决观测数据中的三个技术问题：（i）整体 QoL 和 HrQoL 的区别，（ii）不同时间用途类别的相关性以及时间用途数据的份额结构，以及（iii）横断面设置中时间用途和 HrQoL 评分之间的反向因果关系。此外，我们开发了一种基于 metamodel 的算法，以有效地总结主要计量经济学模型中的大量估计值。最后，我们说明了在前列腺癌治疗的实证 CEA 中使用我们的算法计算生产力和寻求医疗保健的时间成本的方法。
我们提供了 metamodel 算法的估计值。将这些估计值纳入实证 CEA 会使增量成本效益比降低 27%。
我们的估计值可以促进将生产力和寻求医疗保健的时间纳入专家组建议的 CEA 中。
