Expanding the Scope of Costs and Benefits for Economic Evaluations in Health: Some Words of Caution

Excerpt

Discussions regarding the appropriate scope of costs and benefits for inclusion in economic evaluation in healthcare have been an important strand in the literature for much of the last two decades. Almost from the beginning of the use of cost-effectiveness analysis in healthcare, there have been discussions regarding whether productivity costs should be included and—if so—how. Relatively quickly, the discussions moved on to whether so-called unrelated medical care costs should be included, which in turn was extended to consideration of future non-medical costs. Subsequently, attention shifted to capturing the quality-of-life effects of therapies on carers and then, more broadly, on members of the family/household. This discussion developed into ‘spillover effects’—the impacts of interventions on members of the household of the individual receiving therapy. Most recently, the Second Panel on Cost Effectiveness in Health and Medicine proposed the use of ‘impact inventories’—described as a “structured table that contains consequences both inside and outside the formal healthcare sector” [1‐8]. I argue that, with current approaches to health technology assessment, including spillover effects in economic evaluations will exacerbate an already substantial inequity in the value and voice of those who bear the opportunity cost of technology funding decisions, and therefore, spillover effects should not be routinely included in economic evaluations. …