Future medical and non-medical costs and their impact on the cost-effectiveness of life-prolonging interventions: a comparison of five European countries

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.

The lifetime health and economic burden of obesity in five European countries: what is the potential impact of prevention?

“…The latter costs were relatively low in Greece compared with other countries, because in Greece there is large out‐of‐pocket spending (i.e. private spending), which is not included in health care expenditure databases 53 . Moreover, differences in medical costs for other diseases were calculated using best available data, 53 using inpatient hospital care costs for Greece and multiple cost components for the Netherlands.…”

“…private spending), which is not included in health care expenditure databases 53 . Moreover, differences in medical costs for other diseases were calculated using best available data, 53 using inpatient hospital care costs for Greece and multiple cost components for the Netherlands. In line with a previous study, 14 health outcomes were better in a cohort with a BMI of 30 kg/m 2 compared with 35 kg/m 2 , as higher BMI results in higher risks for obesity‐related diseases.…”

“…The results of SA6 did show a large impact of non‐medical costs on the total lifetime costs and it could therefore be argued that these costs should not be neglected. There is still discussion in the literature whether to include these costs, but there is an increase in favour of the arguments as practical issues can be overcome 20,48,53,65 …”

“…Non‐medical costs were estimated from national household consumption/expenditure surveys in each country considering the household size 55–59 . These costs were included as living longer results in more opportunity to consume other goods and services, such as electricity, gas, housing and water 20,53 . More details about the productivity‐ and non‐medical costs can be found in Appendix S1.…”

“…48,49 For the other three countries these costs were calculated by subtracting the obesity-related costs per capita for diabetes, IHD and stroke from the annual health care spending per capita by sex and age. [50][51][52] See the study of Mokri et al 53 for the complete description of this cost calculation.…”