Considering the societal perspective in economic evaluations: a systematic review in the case of depression

Abstract

Background Depressive disorders are associated with a high burden of disease. However, due to the burden posed by the disease on not only the sufferers, but also on their relatives, there is an ongoing debate about which costs to include and, hence, which perspective should be applied. Therefore, the aim of this paper was to examine whether the change between healthcare payer and societal perspective leads to different conclusions of cost-utility analyses in the case of depression. Methods A systematic literature search was conducted to identify economic evaluations of interventions in depression, launched on Medline and the Cost-Effectiveness Registry of the Tufts University using a ten-year time horizon (2008–2018). In a two-stepped screening process, cost-utility studies were selected by means of specified inclusion and exclusion criteria. Subsequently, relevant findings was extracted and, if not fully stated, calculated by the authors of this work. Results Overall, 53 articles with 92 complete economic evaluations, reporting costs from healthcare payer/provider and societal perspective, were identified. More precisely, 22 estimations (24%) changed their results regarding the cost-effectiveness quadrant when the societal perspective was included. Furthermore, 5% of the ICURs resulted in cost-effectiveness regarding the chosen threshold (2% of them became dominant) when societal costs were included. However, another four estimations (4%) showed the opposite result: these interventions were no longer cost-effective after the inclusion of societal costs. Conclusions Summarising the disparities in results and applied methods, the results show that societal costs might alter the conclusions in cost-utility analyses. Hence, the relevance of the perspectives chosen should be taken into account when carrying out an economic evaluation. This systematic review demonstrates that the results of economic evaluations can be affected by different methods available for estimating non-healthcare costs.

Principles of Economic Evaluation in a Pandemic Setting: An Expert Panel Discussion on Value Assessment During the Coronavirus Disease 2019 Pandemic

“…However, a lack of systematically produced non-health estimates hampers the synthesis of evidence from a valuation and price-setting perspective. Variation in the methods employed to incorporate these non-healthcare perspectives can also be a challenge [44], with results that lead to different conclusions. As better data become available, estimation of non-health effects will improve.…”

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

“…Moreover, our findings regarding the inclusion of social costs in all those articles that described an economic evaluation differed from those in similar work carried out on other diseases 84 such as Alzheimer´s disease, 21 where the proportion of social costs in economic evaluations reached more than two-thirds, and depression, where the figure was 42%. 23 By contrast, for DM the percentage of economic evaluation studies which included social costs was close to that in the case of rare diseases, where it was only 11%. 24…”

Range of invasive meningococcal disease sequelae and health economic application – a systematic and clinical review

“…By contrast, EEs that include a narrow range of sequelae may underestimate the burden of IMD and its health and economic impact, and thus fail to grasp the cost-effectiveness of IMD interventions, as demonstrated in Beck et al (2021) [ 15 ]. A recent systematic review of economic evaluations in depression has shown that changing from a narrow payer perspective to a broader societal perspective (e.g., considering the burden on caregivers as well as patients) can change the outcome of the analysis and thus affect policy decisions [ 34 ]. Systematic reviews are better suited to capture the burden of disease and thus to be used in EEs, yet they rely on the quality of included studies.…”