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Epstein N, Simon-Tuval T, Berchenko Y. Context-Specific Estimation of Future Unrelated Medical Costs and Their Impact on Cost-Effectiveness Analyses. PHARMACOECONOMICS 2023; 41:1275-1286. [PMID: 37329391 DOI: 10.1007/s40273-023-01290-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES This study constructed and applied procedures for the estimation of unrelated future medical costs (UFMC) of women with breast cancer in Israel (as a case study) and examined the influence of including UFMC in cost-effectiveness analyses (CEAs). METHODS Part I consisted of a retrospective cohort study based on patient-level claims data of both patients with breast cancer and matched controls during 14 years of follow-up. UFMC were estimated as (a) the annual average all-cause healthcare costs of the control subjects, and (b) as predicted values based on a generalized linear model (GLM) adjusted to patients' characteristics. Part II consisted of a CEA performed using a Markov simulation model comparing regimens of chemotherapy with/without trastuzumab, both excluding and including UFMC and for each of the UFMC estimates separately. All costs were adjusted to 2019 prices. Costs and QALYs were discounted at a yearly rate of 3%. RESULTS The average annual healthcare costs in the control group were $2328 (± $5662). The corresponding incremental cost-effectiveness ratio (ICER) was $53,411/QALY and $55,903/QALY, when UFMC were excluded or included, respectively. Hence, trastuzumab was not considered cost-effective compared with a threshold of willingness-to-pay of $37,000 per QALY, regardless of the inclusion of UFMC. When UFMC were estimated on the basis of the prediction model, the ICERs were $37,968/QALY and $39,033/QALY, when UFMC were excluded or included, respectively. Thus, in this simulation, trastuzumab was not considered cost-effective, independent of the inclusion of UFMC. CONCLUSION Our case study revealed that the inclusion of UFMC had modest effect on the ICERs, and thus did not alter the conclusion. Thus, we should estimate context-specific UFMC if they are expected to change the ICERs significantly, and transparently report the corresponding assumptions to uphold the integrity and reliability of the economic evaluation.
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Affiliation(s)
- Noga Epstein
- Department of Industrial Engineering and Management, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tzahit Simon-Tuval
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O Box 653, 8410501, Beer-Sheva, Israel.
| | - Yakir Berchenko
- Department of Industrial Engineering and Management, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kim DD. Accounting for Nonhealth and Future Costs in Cost-Effectiveness Analysis: Distributional Impacts of a US Cancer Prevention Strategy. PHARMACOECONOMICS 2023; 41:1151-1164. [PMID: 37195368 PMCID: PMC10189225 DOI: 10.1007/s40273-023-01275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To provide up-to-date and comprehensive US data tables to estimate future net resource use, including nonlabor market production, and examine distributional impacts of including nonhealth and future costs in cost-effectiveness results. METHODS Using a published US cancer prevention simulation model, the paper evaluated the lifetime cost effectiveness of implementing a 10% excise tax on processed meats across age- and sex-specific population subgroups. The model examined multiple scenarios accounting for cancer-related healthcare expenditure (HCE) only, cancer-related and unrelated background HCE, adding productivity benefits (i.e., patient time, cancer-related productivity loss, and background labor and nonlabor market production), and with nonhealth consumption costs, adjusted for household economies of scale. Additional analyses include using population-average versus age-sex-specific estimates for quantifying production and consumption value, as well as comparing direct model estimation versus postcorrections with Meltzer's approximation for incorporating future resource use. RESULTS Accounting for nonhealth and future costs impacted cost-effectiveness results across population subgroups, often leading to changes in "cost-saving" determination. Including nonlabor market production had a noticeable impact on estimating future resource use and reduced the bias toward undervaluing productivity among females and older populations. The use of age-sex-specific estimates resulted in less favorable cost-effectiveness results compared with population-average estimates. Meltzer's approximation provided reasonable corrections among the middle-aged population for re-engineering cost-effectiveness ratios from a healthcare sector to a societal perspective. CONCLUSION With updated US data tables, this paper can help researchers conduct a comprehensive value assessment to reflect net resource use (health and nonhealth resource use minus production value) from a societal perspective.
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Affiliation(s)
- David D Kim
- Department of Medicine, Section of Hospital Medicine, The University of Chicago, 5841 South Maryland Ave., MC 5000, Chicago, IL, 60637, USA.
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Mokri H, Kvamme I, de Vries L, Versteegh M, van Baal P. Future medical and non-medical costs and their impact on the cost-effectiveness of life-prolonging interventions: a comparison of five European countries. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:701-715. [PMID: 35925501 DOI: 10.1007/s10198-022-01501-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/05/2022] [Indexed: 05/20/2023]
Abstract
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.
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Affiliation(s)
- Hamraz Mokri
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Ingelin Kvamme
- Institute for Medical Technology Assessment(iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Linda de Vries
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Matthijs Versteegh
- Institute for Medical Technology Assessment(iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Pieter van Baal
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Xu T, Xu L, Xi H, Zhang Y, Zhou Y, Chang N, Yang W, Zhang Y, Wang M, Ju Q, Yang X, Chen X, Che Y, Chen F, Qu S, Zhang J. Assessment of Financial Toxicity Among Patients With Advanced Lung Cancer in Western China. Front Public Health 2022; 9:754199. [PMID: 35096733 PMCID: PMC8790143 DOI: 10.3389/fpubh.2021.754199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Lung cancer is the leading source of cancer-caused disability-adjusted life years. Medical cost burden impacts the well-being of patients through reducing income, cutting daily expenses, curtailing leisure activities, and depleting exhausting savings. The COmprehensive Score for Financial Toxicity (COST) was created and validated by De Souza and colleagues. Our study intends to measure the financial burdens of cancer therapy and investigate the link between financial toxicity and health-related quality of life (HRQoL) in an advanced lung cancer population. Methods: Patients aged ≥ 18 years with confirmed stage III to IV lung cancer were eligible. The COST questionnaire verified by de Souza et al. was used to identify financial toxicity. Multivariable linear regression analysis with log transformation univariate analysis and Pearson correlations were used to perform the analysis. Results: The majority of the patients (90.8%, n = 138/152) had an annual income of $50,000 ($7,775). The cohort's insurance situation was as follows: 64.5% of the cohort had social insurance, 20.4% had commercial insurance, and 22.0% had both. Patients who were younger age (50-59, P < 0.001), employed but on sick leave, and had lower income reported increased levels of financial toxicity (P < 0.05). The risk factors for high financial toxicity: (i) younger age (50-59), (ii) <1 month of savings, and (iii) being employed but on sick leave. Increased financial toxicity is moderately correlated with a decrease in QoL. Conclusion: Poorer psychological status and specific demographics are linked to increased financial toxicity (lower COST). Financial toxicity has a modest relationship with HRQoL and may have a clear link with HRQoL measurements.
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Affiliation(s)
- Tianqi Xu
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.,School of Public Health, Air Force Medical University, Xi'an, China
| | - Leidi Xu
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Hangtian Xi
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.,School of Public Health, Air Force Medical University, Xi'an, China
| | - Yong Zhang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ying Zhou
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ning Chang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Wenhui Yang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.,School of Public Health, Air Force Medical University, Xi'an, China
| | - Yan Zhang
- Szechwan Maternal and Child Care Service Centre, Szechwan, China
| | - Ming Wang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Qing Ju
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xuemin Yang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xiangxiang Chen
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yinggang Che
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Fulin Chen
- College of Life Sciences, Northwest University, Xi'an, China
| | - Shuoyao Qu
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jian Zhang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China.,College of Life Sciences, Northwest University, Xi'an, China
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Jiang S, Wang Y, Zhou J, Jiang Y, Liu GGE, Wu J. Incorporating future unrelated medical costs in cost-effectiveness analysis in China. BMJ Glob Health 2021; 6:e006655. [PMID: 34702751 PMCID: PMC8549663 DOI: 10.1136/bmjgh-2021-006655] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
The occurrence of future unrelated medical costs is a direct consequence of life-prolonging interventions, but most pharmacoeconomic guidelines recommend the exclusion of these costs. The Chinese guidelines were updated in 2020, taking an exclusion approach for the future unrelated medical cost. We notice the research surrounding this issue continues in other countries and leads to an inclusion recommendation in some guidelines. Meanwhile, this issue has not been discussed in China, reflecting an urgent need for extensive research on its impact. We reviewed the theoretical and practical studies surrounding the inclusion of future unrelated medical costs, summarised the landscape of guidelines in other jurisdictions. We found that the inclusion would increase the internal and external consistency of economic evaluation and the comparability of results between different jurisdictions. However, more research is needed surrounding this issue. We proposed a future research agenda to inform the update of Chinese guidelines. We recommend research on individual-level healthcare reimbursement data and end-of-life costs from hospital administrative data to generate the age-specific, sex-specific and condition-specific costs. We also recommend establishing a formal process to evaluate the ethical and economic impact of including future unrelated medical costs and adjust the threshold accordingly in the guidelines.
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Affiliation(s)
- Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yitong Wang
- Public Health Department, Aix-Marseille-University, Marseille, France
| | - Junwen Zhou
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Guangzhou, China
| | | | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
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