How relevant are social costs in economic evaluations? The case of Alzheimer’s disease

Abstract

Background The main objective of this study was to analyse how the inclusion (exclusion) of social costs can alter the results and conclusions of economic evaluations in the field of Alzheimer’s disease interventions. Methods We designed a systematic review that included economic evaluations in Alzheimer’s disease. The search strategy was launched in 2000 and ran until November 2018. The inclusion criteria were: being an original study published in a scientific journal, being an economic evaluation of any intervention related to Alzheimer’s disease, including social costs (informal care costs and/or productivity losses), being written in English, using QALYs as an outcome for the incremental cost–utility analysis, and separating the results according to the perspective applied. Results It was finally included 27 studies and 55 economic evaluations. Around 11% of economic evaluations changed their main conclusions. More precisely, three of them concluded that the new intervention became cost-effective when the societal perspective was considered, whereas when using just the health care payer perspective, the new intervention did not result in a cost–utility ratio below the threshold considered. Nevertheless, the inclusion of social cost can also influence the results, as 37% of the economic evaluations included became the dominant strategy after including social costs when they were already cost-effective in the health care perspective. Conclusions Social costs can substantially modify the results of the economic evaluations. Therefore, taking into account social costs in diseases such as Alzheimer’s can be a key element in making decisions about public financing and pricing of health interventions.

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

“…Nevertheless, even though there are no previous studies that have performed such analysis in the field of depression, and therefore, no direct comparison could be done, the results obtained are in line with those in previous papers in which the authors aimed to analyse the role played by societal costs in economic evaluations in different therapeutic areas [ 22 , 84 – 86 ]. Particularly, the consideration of productivity losses could alter the decisions regarding reimbursement of expensive drugs in almost one-third of the cases [ 85 ].…”

“…Regarding the role of informal caregivers, previous studies proved that the impact of informal care costs differed between studies, depending mainly on the disease considered [ 22 , 84 , 86 ]. These papers evidences the fact that informal care costs were only present in one of the economic evaluations considered, making visible that the role played by non-professional care costs in economic evaluations of depression are not quite frequent.…”

“…One of the main reasons is the selection of the most appropriate perspective [ 21 ]. Taking into account the importance of non-healthcare costs, it seems to be necessary to focus on encouraging their inclusion in any economic evaluation as well as emphasizing its role, as it has been done in other areas [ 22 ]. However, to the best of our knowledge, there is no evidence in the field of depression that has assessed the relevance of including or excluding costs beyond the healthcare ones.…”

Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain

“…Therefore, it would not be incorrect to point out that eclecticism is relevant when choosing the valuation technique. In any case, opportunity cost method prevails in the literature [46,73] and a growing use of different methods is being recommended [46,56]. The present work has several limitations.…”

“…Interestingly, while in the case of productivity losses there has been a very intense debate and there exists an extensive literature comparing the two main methods used [71,72], in the case of informal care there is no such intense methodological discussion [48]. This is possibly due to the fact that, firstly, the researchers have focused on generating evidence that shows the relevance of informal care in studies of the cost of illnesses and its inclusion in economic evaluations [73]. Secondly, there is a wide research path in the field of informal care, of which the assessment of care Amounts in euros of 2017; Scenario 1 take for estimations average income, scenario 2 lower income range and scenario 3 upper income range.…”