Kim et. al. of Tufts Medical Center published an examination in the journal Pharmacoeconomics assessing CEA and Global Health CEA registries, containing 6907 cost-per-quality-adjusted-life-year (QALY) and 698 cost-per-disability-adjusted-life-year (DALY) studies published through 2018. Researchers examined how often published CEAs included non-health consequences and their impact on ICERs, including 45 country-specific guidelines to examine recommended analytic perspectives.
Results suggested that analyses had mis-specified or no clearly stated perspective. CEAs rarely included unrelated medical costs and impacts on non-healthcare sectors. The most common non-health consequence was productivity loss in the cost-per-QALY studies (12%) and patient transportation in the cost-per-DALY studies (21%). The median ICER was $US26,000/QALY and/or $US430/DALY, with 8% cost saving and DALY averting.
Key points for decision makers included a reminder that the analytic perspective assumed in cost-effectiveness analysis determines which costs and benefits are included, and thus the study perspective must be clearly identified. When a societal perspective was used, authors often did not apply it as broadly as intended. The use of a healthcare payer or a healthcare sector perspective persists in most published studies and national guidelines because “relevant” non-health benefits and costs are often difficult to define and may depend on the context. The consistent use of the impact inventory and reporting of disaggregate outcomes can help reduce discrepancies across analyses capturing non-health consequences.
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