A comprehensive framework for considering additional unintended consequences in economic evaluation

Abstract

Background: In recent years there has been a growth in economic evaluations that consider indirect health benefits to populations due to advances in mathematical modeling. In addition, economic evaluations guidelines have suggested the inclusion of impact inventories to include non-health direct and indirect consequences. We aim to bring together this literature, together with the broader literature on internalities and externalities to propose a comprehensive approach for analysts to identify and characterize all unintended consequences in economic evaluations. Methods: We present a framework to assist analysts identify and characterize additional costs and effects beyond that of direct health impact primarily intended to be influenced by the intervention/technology. We build on previous checklists to provide analysts with a comprehensive framework to justify the inclusion or exclusion of effects, supporting the use of current guidelines, to ensure any unintended effects are considered. We illustrate this framework with examples from immunization. These were identified from a previous systematic review, PhD thesis work, and general search scoping in PubMed databases. Results: We present a comprehensive framework to consider additional consequences, exemplified by types and categories. We bring this and other guidance together to assist analysts identify possible unintended consequences whether taking a provider or societal perspective. Conclusions: Although there are many challenges ahead to standardize the inclusion of additional consequences in economic evaluation, we hope by moving beyond generic statements to reporting against a comprehensive framework of additional effects we can support further consistency in this aspect of cost-effectiveness analysis going forward.

Inclusion of Additional Unintended Consequences in Economic Evaluation: A Systematic Review of Immunization and Tuberculosis Cost-Effectiveness Analyses

“…This is the first review to evaluate the inclusion of additional unintended consequences in economic evaluation studies as presented in the framework by Nymark and Vassall [ 16 ]. However, we only included vaccine and tuberculosis CEAs in our search.…”

“…The results of this review should not be taken to suggest that all additional consequences should be included in every economic evaluation but instead should encourage analysts to provide transparency where unintended additional consequences are excluded and to provide the reasons for this. We have previously provided a clear framework that can be used [ 16 ].…”

“…We presented a comprehensive framework elsewhere that identifies and characterizes additional unintended costs and effects beyond that of the direct health impact primarily intended by the intervention/technology [ 16 ]. We briefly present and describe the framework (Fig.…”

“…We presented a comprehensive framework elsewhere [ 16 ] to assist analysts in identifying and characterizing the additional costs and effects beyond that of the direct health impact that was primarily intended to be influenced by the intervention/technology. We refer to these additional costs and effects hereafter as “additional unintended consequences” [ 16 ]. On the whole, the inclusion of additional unintended consequences is relevant in studies using the societal perspective.…”

An Integrated Cost Model Based on Real Patient Flow: Exploring Surgical Hospitalization in a Teaching Hospital

“…Several studies have been carried out with the objective of identifying health costs and developing methods to improve this research, thus contributing to better decision making, based on more reliable evidence [13,14,15]. In this context, due to the lack of nancial resources, the health decision-maker should be supported with the best possible basis, such as systematic analysis and measurement, that is more consistent than simply repeating decisions or take them by instinct.…”