Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
Eur J Health Econ. 2024 Sep;25(7):1239-1260. doi: 10.1007/s10198-023-01658-8. Epub 2024 Jan 23.
An important issue in economic evaluations is determining whether all relevant impacts are considered, given the perspective chosen for the analysis. Acknowledging that patients are not isolated individuals has important implications in this context. Increasingly, the term "spillovers" is used to label consequences of health interventions on others. However, a clear definition of spillovers is lacking, and as a result, the scope of the concept remains unclear. In this study, we aim to clarify the concept of spillovers by proposing a definition applicable in health economic evaluations. To illustrate the implications of this definition, we highlight the diversity of potential spillovers through an expanded impact inventory and conduct a mapping review that outlines the evidence base for the different types of spillovers. In the context of economic evaluations of health interventions, we define spillovers as all impacts from an intervention on all parties or entities other than the users of the intervention under evaluation. This definition encompasses a broader range of potential costs and effects, beyond informal caregivers and family members. The expanded impact inventory enables a systematic approach to identifying broader impacts of health interventions. The mapping review shows that the relevance of different types of spillovers is context-specific. Some spillovers are regularly included in economic evaluations, although not always recognised as such, while others are not. A consistent use of the term "spillovers", improved measurement of these costs and effects, and increased transparency in reporting them are still necessary. To that end, we propose a research agenda.
在经济评估中,一个重要的问题是,鉴于所选择的分析视角,是否考虑了所有相关的影响。承认患者不是孤立的个体,这在这种情况下具有重要意义。“溢出效应”一词越来越多地被用来描述卫生干预措施对他人的后果。然而,目前缺乏对溢出效应的明确定义,因此该概念的范围仍不清楚。在这项研究中,我们旨在通过提出一个适用于健康经济评估的定义来澄清溢出效应的概念。为了说明这一定义的含义,我们通过扩展影响清单突出了潜在溢出效应的多样性,并进行了映射审查,概述了不同类型溢出效应的证据基础。在卫生干预措施经济评估的背景下,我们将溢出效应定义为评估干预措施的使用者以外的所有各方或实体因干预措施而产生的所有影响。这个定义涵盖了更广泛的潜在成本和效果,超出了非正式照顾者和家庭成员的范围。扩展的影响清单使我们能够系统地识别卫生干预措施的更广泛影响。映射审查表明,不同类型溢出效应的相关性是特定于情境的。有些溢出效应经常被纳入经济评估中,尽管并不总是被认为是这样,而有些则没有。术语“溢出效应”的一致使用、对这些成本和效果的更好衡量以及在报告方面的透明度提高仍然是必要的。为此,我们提出了一个研究议程。
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