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Cost-Effectiveness Analysis in Healthcare: Methodological Advances and Practical Applications from a Societal Perspective

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 21344

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Special Issue Editors

Dr. Susanne Mayer

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Guest Editor

Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
Interests: costing; unit cost; trial-based economic evaluation; inter-sectoral costs and benefits; socioeconomic gradient in health behavior

Dr. Michael Berger

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Guest Editor

Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria
Interests: health policy analysis; health economic evaluation; health econometrics; efficiency in healthcare systems; socioeconomics of health

Dr. Ghislaine Van Mastrigt

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Guest Editor

Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
Interests: health economic evaluation; health-relateded quality of life; systematic reviews; research methods; clinical practice guidelines and education

Special Issue Information

Dear Colleagues,

Rising healthcare costs go hand in hand with an increasing need for economic evaluations—for instance, cost-effectiveness analyses in the field of public health. However, adopting a broad societal perspective to cover all relevant costs from multiple sectors affected by the spillover effects of healthcare interventions remains a methodological and practical challenge to this day despite its growing popularity and application. This Special Issue calls for studies advancing the methodological foundation of economic evaluations conducted from a societal viewpoint. This includes theoretical contributions as well as applied examples of rigorously conducted cost-effectiveness analyses covering consequences beyond costs in the health and social care sectors. For this Special Issue, papers including systematic literature reviews addressing these topics are invited, especially those combining novel methods contributing to capturing the consequences of healthcare interventions in a wide variety of sectors. This collection of articles will contribute to the health economic literature by broadening the evidence base from economic evaluations to make optimal societal decisions and by providing insights into the practical aspects of conducting economic evaluations from a societal perspective.

Dr. Susanne Mayer
Dr. Michael Berger
Dr. Ghislaine Van Mastrigt
Guest Editors

Manuscript Submission Information

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Keywords

health economic evaluation (model and trial-based)
cost of illness
cost-effectiveness
societal perspective
intersectoral costs
cost
outcome
multisectoral methodology
systematic reviews
public health

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Published Papers (4 papers)

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Research

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12 pages, 292 KiB

Open AccessArticle

Cost-Benefit Analysis versus Cost-Effectiveness Analysis from a Societal Perspective in Healthcare

by Robert J. Brent

Int. J. Environ. Res. Public Health 2023, 20(5), 4637; https://doi.org/10.3390/ijerph20054637 - 6 Mar 2023

Cited by 28 | Viewed by 8808

Abstract

Cost-effectiveness analysis (CEA) is the main way that economic evaluations are carried out in the health care field. However, CEA has limited validity in deciding whether any health care evaluation is socially worthwhile and hence justifies funding. Cost-Benefit Analysis (CBA) is the economic evaluation method that should be used to help decide what to invest in when the objective is to record the impact on everyone in society. Cost-utility analysis (CUA), which has its roots in CEA, can be converted into CBA under certain circumstances that are not general. In this article, the strengths and weaknesses of CEA relative to CBA are analyzed in stages, starting in its most classical form and then proceeding via CUA to end up as CBA. The analysis takes place mainly in the context of five actual dementia interventions that have already been found to pass a CBA test. The CBA data is recast into CEA and CUA terms in tabular form in order that the contrast been CEA and CBA is most transparent. We find that how much of the fixed budget that is used up to fund other alternatives determines how much is left over to fund the particular intervention one is evaluating. Full article

(This article belongs to the Special Issue Cost-Effectiveness Analysis in Healthcare: Methodological Advances and Practical Applications from a Societal Perspective)

13 pages, 589 KiB

Open AccessArticle

Cost-Effectiveness of Positive Memory Training (PoMeT) for the Treatment of Depression in Schizophrenia

by Judit Simon, Noemi Kiss, Kees Korrelboom, David Kingdon, Til Wykes, Peter Phiri, Mark van der Gaag, M. Fazil Baksh and Craig Steel

Int. J. Environ. Res. Public Health 2022, 19(19), 11985; https://doi.org/10.3390/ijerph191911985 - 22 Sep 2022

Cited by 1 | Viewed by 2608

Abstract

The Positive Memory Training (PoMeT) trial demonstrated reduced depression symptoms at 3 months for schizophrenia, but its longer-term outcome and cost impacts remain unknown. This study is a within-trial cost-utility analysis with quality-adjusted life years (QALYs) as outcome based on health-related quality of life (HRQoL) measurement and secondary outcome analyses of capability well-being. The incremental cost-effectiveness of PoMeT was compared to Treatment As Usual only (TAU) over 9 months from the ‘health and social’ care and ‘societal’ perspectives. Uncertainty was explored using bootstrapping and sensitivity analyses for cost outliers and outcome methods. HRQoL improvement was observed for both PoMeT and TAU at 3 months, but reached statistical significance and was sustained only for TAU. There was no change in capability well-being and no significant group difference in QALYs gained over 9 months. Mean intervention cost was GBP 823. Compared to TAU, PoMeT had significantly higher mental health care costs (+GBP 1251, 95% CI GBP 185 to GBP 2316) during the trial, but ‘health and social care’ and ‘societal’ cost differences were non-significant. Compared to the before-trial period, psychiatric medication costs increased significantly in both groups. The probability of PoMeT being cost-effective in the given format over 9 months was <30% and decreased further in sensitivity analyses.. Generalizability remains limited since the before-after cost analysis revealed additional treatment effects also in the TAU group that likely diminished the incremental impacts and cost-effectiveness of PoMeT. It is not clear whether an active post-intervention follow-up could result in sustained longer-term effects and improved cost-effectiveness. Full article

(This article belongs to the Special Issue Cost-Effectiveness Analysis in Healthcare: Methodological Advances and Practical Applications from a Societal Perspective)

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15 pages, 714 KiB

Open AccessArticle

Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort

by Ghislaine van Mastrigt, Caroline van Heugten, Anne Visser-Meily, Leonarda Bremmers and Silvia Evers

Int. J. Environ. Res. Public Health 2022, 19(17), 11110; https://doi.org/10.3390/ijerph191711110 - 5 Sep 2022

Cited by 11 | Viewed by 3081

Abstract

(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year −EUR 14,277 (95% confidence interval −EUR 17,319, −EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years. Full article

(This article belongs to the Special Issue Cost-Effectiveness Analysis in Healthcare: Methodological Advances and Practical Applications from a Societal Perspective)

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Review

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14 pages, 514 KiB

Open AccessReview

Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review

by Dirk Steijger, Chandrima Chatterjee, Wim Groot and Milena Pavlova

Int. J. Environ. Res. Public Health 2023, 20(1), 505; https://doi.org/10.3390/ijerph20010505 - 28 Dec 2022

Cited by 8 | Viewed by 5507

Abstract

Background: Cost-effectiveness is a tool to maximize health benefits and to improve efficiency in healthcare. However, efficient outcomes are not always the most equitable ones. Distributional cost-effectiveness analysis (DCEA) offers a framework for incorporating equity concerns into cost-effectiveness analysis. Objective: This systematic review aims to outline the challenges and limitations in applying DCEA in healthcare settings. Methods: We searched Medline, Scopus, BASE, APA Psych, and JSTOR databases. We also included Google Scholar. We searched for English-language peer-reviewed academic publications, while books, editorials and commentary papers were excluded. Titles and abstract screening, full-text screening, reference list reviews, and data extraction were performed by the main researcher. Another researcher checked every paper for eligibility. Details, such as study population, disease area, intervention and comparators, costs and health effects, cost-effectiveness findings, equity analysis and effects, and modelling technique, were extracted. Thematic analysis was applied, focusing on challenges, obstacles, and gaps in DCEA. Results: In total, 615 references were identified, of which 18 studies met the inclusion criteria. Most of these studies were published after 2017. DCEA studies were mainly conducted in Europe and Africa and used quality health-adjusted measurements. In the included studies, absolute inequality indices were used more frequently than relative inequality indices. Every stage of the DCEA presented challenges and/or limitations. Conclusion: This review provides an overview of the literature on the DCEA in healthcare as well as the challenges and limitations related to the different steps needed to conduct the analysis. In particular, we found problems with data availability, the relative unfamiliarity of this analysis among policymakers, and challenges in estimating differences among socioeconomic groups. Full article

(This article belongs to the Special Issue Cost-Effectiveness Analysis in Healthcare: Methodological Advances and Practical Applications from a Societal Perspective)

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