Kok Lucy, Koopmans Carl
SEO Amsterdam Economics, University of Amsterdam, The Netherlands.
Vrije Universiteit Amsterdam, The Netherlands.
Med Decis Making. 2025 Jul;45(5):614-622. doi: 10.1177/0272989X251333787. Epub 2025 Apr 25.
BackgroundHealth interventions affect people's welfare directly by impacting people's health but also indirectly via a change in consumption and leisure time caused by the change in health. This study discusses 2 ongoing issues in the economic evaluation of health interventions. The first is how to value a change in the amount of leisure time of a patient. The second issue concerns the valuation of a change in production.MethodsWe present a theoretical model that assumes that individual utility depends on health, consumption, and leisure time. We assume that the total stock of time consists of 3 components: leisure time, working time, and recovery time. The model takes a societal perspective and assumes that individuals optimize their utility, conditional on time and budget restrictions.ResultsFor the first issue, the model indicates that the value of a change in the stock of time available for leisure and work has to be added to the direct effects of a health intervention, instead of only a change in work hours. For the second issue, the model indicates that in case of a change in longevity, only the change in taxes paid may be counted because the income change is included in the value of the change in quality-adjusted life-years. A numerical example shows that this approach may counterbalance the potential overestimation of the welfare effects of treatments with the human capital method and underestimation related to the friction cost method.ConclusionWe propose a new method that includes the welfare effects of health interventions due to a change in the amount of leisure time and avoids double counting of welfare changes, which are included in the direct effects.HighlightsWe present a theoretical model and use it to analyze 2 issues in the economic evaluation of health interventions: the inclusion of leisure time and the valuation of production.The model indicates that the effects of health changes on the amount of both work and leisure hours need to be taken into account in economic evaluation.As to the valuation of production, the model indicates that in case of a change in longevity, only the change in taxes may be counted.We propose the "stock of time" method to value changes in working hours and leisure hours, which may counterbalance potential overestimates and underestimates in established methods.
背景
健康干预措施不仅通过影响人们的健康直接影响其福利，还会因健康变化导致消费和休闲时间的改变而间接产生影响。本研究探讨了健康干预措施经济评估中的两个现存问题。第一个问题是如何评估患者休闲时间量的变化。第二个问题涉及生产变化的评估。
方法
我们提出了一个理论模型，该模型假定个人效用取决于健康、消费和休闲时间。我们假设时间的总存量由三个部分组成：休闲时间、工作时间和恢复时间。该模型从社会角度出发，假定个人在时间和预算限制条件下实现效用最大化。
结果
对于第一个问题，该模型表明，必须将可用于休闲和工作的时间存量变化的价值加到健康干预的直接影响上，而不仅仅是工作时间的变化。对于第二个问题，该模型表明，在寿命发生变化的情况下，仅可计算所缴纳税款的变化，因为收入变化已包含在质量调整生命年变化的价值中。一个数值示例表明，这种方法可能会抵消人力资本法对治疗福利效应的潜在高估以及摩擦成本法相关的低估。
结论
我们提出了一种新方法，该方法纳入了因休闲时间量变化而产生的健康干预的福利效应，并避免了对已包含在直接效应中的福利变化进行重复计算。
要点
我们提出了一个理论模型，并利用它来分析健康干预措施经济评估中的两个问题：休闲时间的纳入和生产的评估。
该模型表明，在经济评估中需要考虑健康变化对工作和休闲时间量的影响。
关于生产的评估，该模型表明，在寿命发生变化的情况下，仅可计算税款的变化。
我们提出了“时间存量”方法来评估工作时间和休闲时间的变化，这可能会抵消既定方法中的潜在高估和低估。
