Assessing the Effect of Including Social Costs in Economic Evaluations of Diabetes-Related Interventions: A Systematic Review

Abstract

Background The economic burden of diabetes from a societal perspective is well documented in the cost-of-illness literature. However, the effect of considering social costs in the results and conclusions of economic evaluations of diabetes-related interventions remains unknown. Objective To investigate whether the inclusion of social costs (productivity losses and/or informal care) might change the results and conclusions of economic evaluations of diabetes-related interventions. Methods A systematic review was designed and launched on Medline and the Cost-Effectiveness Analysis Registry from the University of Tufts, from the year 2000 until 2018. Included studies had to fulfil the following criteria: i) being an original study published in a scientific journal, ii) being an economic evaluation of an intervention on diabetes, iii) including social costs, iv) being written in English, v) using quality-adjusted life years as outcome, and vi) separating the results according to the perspective applied. Results From the 691 records identified, 47 studies (6.8%) were selected. Productivity losses were included in 45 of the selected articles (73% used the human capital approach) whereas informal care costs in only 13 (when stated, the opportunity cost method was used in seven studies and the replacement cost in one). The 47 studies resulted in 110 economic evaluation estimations. The inclusion of social costs changed the conclusions in 8 estimations (17%), 6 of them switching from not cost-effective from the healthcare perspective to cost-effective or dominant from the societal perspective. Considering social costs altered the results from cost-effective to dominant in 9 estimations (19%). Conclusion When social costs are considered, the results and conclusions of economic evaluations performed in diabetes-related interventions can alter. Wide methodological variations have been observed, which limit the comparability of studies and advocate for the inclusion of a wider perspective via the consideration of social costs in economic evaluations and methodological guidelines relating to their estimation and valuation.

Methodological issues in economic evaluations of disease prevention and health promotion: an overview of systematic and scoping reviews

“…DPHP interventions can be evaluated from a number of different perspectives, e.g., the health sector perspective, the public sector perspective or the perspective of particular agencies involved in the system [ 32 ]. The failure to consistently adopt a societal perspective (46% and, in studies with a societal perspective, the omission of certain relevant costs such as those relating to productivity losses and participants’ time, may underestimate the cost-effectiveness of DPHP-measures [ 43 ] and often precludes a deeper understanding of the monetary consequences of DPHP.…”

Social determinants of the Latinx diabetes health disparity: A Oaxaca-Blinder decomposition analysis

“…The results of this study offer another perspective on the factors that contribute to the Latinx diabetes inequity and supports the theory that diabetes needs to be addressed through social policy as much as health policy ( Arcaya et al, 2015 ; Berwick, 2020 ; McKinlay & Marceau, 2000 ). Even though social epidemiology and other medical social sciences have presented strong cases that diabetes is heavily influenced by factors outside of individual health behaviors and genetics, most of the approaches for addressing diabetes rely on individual-level clinical interventions and do not take into consideration the social perspective ( Boles, Kandimalla, & Reddy, 2017 ; Rodriguez-Sanchez, Aranda-Reneo, Oliva-Moreno, & Lopez-Bastida, 2021 ). Considering that most public health and clinical medicine interventions focus on reducing BMI as a means to prevent and manage diabetes, these findings support other scholarship which argues for priority focus to be addressed at the structural level if the aim is to reduce health disparities ( Berwick, 2020 ; Brown et al, 2019 ; Harris & Pamukcu, 2020 ; McKinlay & Marceau, 2000 ).…”

Cómo diseñar o interpretar evaluaciones económicas de intervenciones en diabetes mellitus

“…El resto de las partidas estarán presentes o no en la evaluación dependiendo de la perspectiva adoptada en el análisis 8 . En definitiva, la tipología de costes a considerar en una evaluación económica en el ámbito de la DM puede alterar los resultados y, por consiguiente, las conclusiones y decisiones de la intervención o tecnología sanitaria evaluada 11 .…”