Does the inclusion of societal costs change the economic evaluations recommendations? A systematic review for multiple sclerosis disease

BACKGROUND

Multiple sclerosis imposes a heavy burden on the person who suffers from it and on the relatives, due to the caregiving load involved. The objective was to analyse whether the inclusion of social costs in economic evaluations of multiple sclerosis-related interventions changed results and/or conclusions.

METHODS

A systematic review was launched using Medline and the Cost-Effectiveness Analysis Registry of Tufts University (2000-2019). Included studies should: (1) be an original study published in a scientific journal, (2) be an economic evaluation of any multiple sclerosis-related intervention, (3) include productivity losses and/or informal care costs (social costs), (4) be written in English, (5) use quality-adjusted life years as outcome, and (6) separate the results according to the perspective applied.

RESULTS

Twenty-nine articles were selected, resulting in 67 economic evaluation estimations. Social costs were included in 47% of the studies. Productivity losses were assessed in 90% of the estimations (the human capital approach was the most frequently used method), whereas informal care costs were included in nearly two-thirds of the estimations (applying the opportunity and the replacement-cost methods equally). The inclusion of social costs modified the figures for incremental costs in 15 estimations, leading to a change in the conclusions in 10 estimations, 6 of them changing from not recommended from the healthcare perspective to implemented from the societal perspective. The inclusion of social costs also altered the results from cost-effective to dominant in five additional estimations.

CONCLUSIONS

The inclusion of social costs affected the results/conclusions in multiple sclerosis-related interventions, helping to identify the most appropriate interventions for reducing its economic burden from a broader perspective.

Correction to: How relevant are social costs in economic evaluations? The case of Alzheimer's disease

A correction to this paper has been published: https://doi.org/10.1007/s10198-021-01323-y

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

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.

Using a stated preference discrete choice experiment to assess societal value from the perspective of decision-makers in Europe. Does it work for rare diseases?

OBJECTIVES

To pilot the feasibility of using a discrete choice experiment (DCE) design to investigate individual preferences from the decision-maker perspective regarding the use of public funding for orphan drugs and generate prior information for future experimental designs.

METHODS

A DCE was used on a convenience sample of participants from five European countries (England, France, Germany, Italy and Spain), exploring their preferences in distinct healthcare scenarios involving orphan drugs. A preliminary review of the empirical literature on distributive preferences informed the selection of attributes and their levels in the design. An online questionnaire was used to conduct the DCE survey.

RESULTS

A total of 199 questionnaires were completed. The five country model showed relative preference for some attributes over others: cost of treatment, improvement in health, value for money and availability of treatment alternatives received the greatest attention. However, disease severity, beginning of life, waiting times and side effects were also shown to be important social values that should not be ignored.

CONCLUSIONS

The findings presented in this study provide insight about the preferences that can influence decisions on orphan drugs in different countries. This study also provides valuable prior information that could inform future DCE designs in this area.

Social/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe

OBJECTIVE

The aim of this study was to determine the economic burden from a societal perspective and the health-related quality of life (HRQOL) of patients with juvenile idiopathic arthritis (JIA) in Europe.

METHODS

We conducted a cross-sectional study of patients with JIA from Germany, Italy, Spain, France, the United Kingdom, Bulgaria, and Sweden. Data on demographic characteristics, healthcare resource utilization, informal care, labor productivity losses, and HRQOL were collected from the questionnaires completed by patients or their caregivers. HRQOL was measured with the EuroQol 5-domain (EQ-5D-5L) questionnaire.

RESULTS

A total of 162 patients (67 Germany, 34 Sweden, 33 Italy, 23 United Kingdom, 4 France, and 1 Bulgaria) completed the questionnaire. Excluding Bulgarian results, due to small sample size, country-specific annual health care costs ranged from €18,913 to €36,396 (reference year: 2012). Estimated direct healthcare costs ranged from €11,068 to €22,138; direct non-healthcare costs ranged from €7837 to €14,155 and labor productivity losses ranged from €0 to €8715. Costs are also shown to differ between children and adults. The mean EQ-5D index score for JIA patients was estimated at between 0.44 and 0.88, and the mean EQ-5D visual analogue scale score was estimated at between 62 and 79.

CONCLUSIONS

JIA patients incur considerable societal costs and experience substantial deterioration in HRQOL in some countries. Compared with previous studies, our results show a remarkable increase in annual healthcare costs for JIA patients. Reasons for the increase are the inclusion of non-professional caregiver costs, a wider use of biologics, and longer hospital stays.

Health-related quality of life in patients with spinocerebellar ataxia

INTRODUCTION

The progressive deterioration of patients with spinocerebellar ataxia (SCA) has a major impact on their health-related quality of life (HRQOL). This study evaluates HRQOL in a sample of patients diagnosed with SCA and aims to estimate the predictive ability of a set of sociodemographic variables for the different dimensions of the General Health Questionnaire.

METHODS

A total of 80 patients diagnosed with SCA were assessed using a sociodemographic questionnaire and the SF-36 General Health Questionnaire. The sociodemographic variables studied were sex, age, presence of a carer, employment status, and time elapsed from diagnosis of the disease.

RESULTS

The 8 subscales of the SF-36 show positive and significant correlations to one another. Mean scores obtained on each SF-36 subscale differ between women and men, although this difference is significant only on the general health subscale, with men scoring higher than women. We found significant age differences on the vitality and social function subscales, with higher scores among younger patients (< 34 years). The variable 'presence of a carer' accounts for most of the total variance of the questionnaire.

CONCLUSIONS

The SF-36 is a valid and useful instrument for evaluating HRQOL in patients diagnosed with SCA. Presence of a carer seems to be a determinant of self-perceived quality of life in these patients.

[Routine preoperative screening of asymptomatic patients: beliefs and attitudes of anesthesiologists in the Canary Islands, Spain]

OBJECTIVES

To identify factors that explain anesthesiologists' inappropriate use of preoperative tests in asymptomatic patients scheduled for elective surgery.

MATERIAL AND METHODS

A validated questionnaire was sent to anesthesiologists at university hospitals in the Canary Islands. Information about preoperative testing patterns and reasons for selecting tests was gathered.

RESULTS

The questionnaire was self-administered by 66 anesthesiologists (68% of the total). Scientific knowledge was not the reason why most respondents ordered preoperative tests in asymptomatic individuals. That was the opinion of 95% of anesthesiologists for chest x-rays, 82% for electrocardiograms, and 68% for laboratory tests. Clinical history and a medical examination gave sufficient information for selecting patients in need of specific tests in the opinion of 77.19% of the respondents. Half did not agree that routine electrocardiograms and laboratory tests should be abandoned. The justification for these tests was coverage of medical malpractice liability for 68.42%. Most considered that the need to order preoperative tests in asymptomatic patients increased after age 40.

CONCLUSIONS

Although anesthesiologists admit that their request for preoperative tests in asymptomatic individuals is not supported by scientific evidence, the quest for safety and legal protection from the consequences of potential adverse consequences of providing anesthesia affects the selection of preoperative tests for asymptomatic patients.

[Socio-economic costs of mental health in the Canary Islands, Spain, in 2002]

OBJECTIVE

To evaluate the economic impact in terms of direct and indirect costs of the mental health in Canary Islands (Spain) in 2002.

DESIGN

The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 2002. The human capital theory approach has been used.

SETTING

Canary Islands, Spain, including primary health care and inpatient care.

PARTICIPANTS

Mental health patients.

MAIN MEASUREMENTS

Direct health costs (inpatients, ambulatory care, primary health care, and drugs). Indirect costs (premature death, short-term illness, and permanent disability).

RESULTS

The total costs of mental health were 189.59 million euros. The direct health costs were 81.67 million euros, constituting 43% of the total costs and 5.2% of the total public health care budget in this region. The indirect costs of mental health were 107.92 million euros, representing 57% of the total costs.

CONCLUSIONS

Although this study adopts a conservative approach, the high socio-economic cost of the mental health helps us to define better the dimension of the problem to establish priorities besides opening a way towards cost-effectiveness studies that allow a more transparent debate on this topic.

Bone mineral density referral for dual-energy X-ray absorptiometry using quantitative ultrasound as a prescreening tool in postmenopausal women from the general population: a cost-effectiveness analysis

The aim of our study was to assess, from the perspective of the National Health Services in Spain, the cost-effectiveness of quantitative ultrasound (QUS) as a prescreen referral method for bone mineral density (BMD) assessment by dual-energy X-ray absorptiometry (DXA) in postmenopausal women of the general population. Using femoral neck DXA and heel QUS. We evaluated 267 consecutive postmenopausal women 65 years and older and attending primary care physician offices for any medical reason. Subjects were classified as osteoporotic or nonosteoporotic (normal or osteopenic) using the WHO definition for DXA. Effectiveness was assessed in terms of the sensitivity and specificity of the referral decisions based on the QUS measurement. Local costs were estimated from health services and actual resource used. Cost-effectiveness was evaluated in terms of the expected cost per true positive osteoporotic case detected. Baseline prevalence of osteoporosis evaluated by DXA was 55.8%. The sensitivity and specificity for the diagnosis of osteoporosis by QUS using the optimal cutoff thresholds for the estimated heel BMD T-score were 97% and 94%, respectively. The average cost per osteoporotic case detected based on DXA measurement alone was 23.85 euros. The average cost per osteoporotic case detected using QUS as a prescreen was 22.00 euros. The incremental cost-effectiveness of DXA versus QUS was 114.00 euros per true positive case detected. Our results suggest that screening for osteoporosis with QUS while applying strict cufoff values in postmenopausal women of the general population is not substantially more cost-effective than DXA alone for the diagnosis of osteoporosis. However, the screening strategy with QUS may be an option in those circumstances where the diagnosis of osteoporosis is deficient because of the difficulty in accessing DXA equipment.

Preoperative assessment

Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. In this article, we aim to emphasise: why preoperative assessment is important; how it should be done, and by whom; what can be expected; and the importance of test selection based on patients' needs and on scientific evidence of effectiveness. We outline the roles of preoperative medical assessment in otherwise healthy patients. Clinical history, preoperative questionnaires, physical examination, routine tests, individual risk-assessment, and fasting policies are investigated by review of published work. Cost of routine preoperative assessment, the anaesthetist's legal responsibility, and patients'views in the preoperative process are also considered. A thorough clinical preoperative assessment of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care. Education and training of medical doctors should be more scientifically guided, emphasising the relevance of effectiveness, and cost-effectiveness in clinical decision-making and complemented by audit.

[Socioeconomic costs of cardiovascular disease and cancer in the Canary Islands (Spain) in 1998]

OBJECTIVE

To evaluate the economic impact in terms of direct and indirect costs of the cardiovascular disease and cancer in the Canary Islands in 1998.

METHODS

The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence costs, i.e., the costs produced in 1998. Direct costs were divided into hospitalization costs, outpatient costs, primary health care costs, and drug costs while indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory and the friction cost method.

RESULTS

The total costs of cardiovascular disease and cancer were 246.11 and 193.72 million euros respectively. The direct costs of the two diseases were 134.44 and 58.04 million euros respectively, representing 55% and 30% of total costs and 16% of total health care expenditure in this region. The indirect costs of these two diseases were 111.68 and 135.68 million euros respectively, representing 45% and 70% of total costs. Use of the friction cost method revealed that indirect costs decreased by 88% for cardiovascular disease and those for cancer decreased by 77%.

CONCLUSIONS

Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the annual socioeconomic cost of cardiovascular disease and cancer in the Canary Islands was high, amounting to 440 million euros.

[Cost analysis and potential savings related to the use of preoperative tests in the hospitals of the Canary Islands [Spain]]

OBJECTIVE

To estimate the potential cost savings that might take place in the Canary Islands Health Service (CHS) through the appropriate scientific use of preoperative tests, using information obtained from five public university hospitals.

METHODS

A questionnaire was completed by 55 anesthesiologists, representing 60% of the total in the CHS. The questionnaire paid special attention to the most frequently used preoperative tests: chest radiograph, electrocardiogram, laboratory tests, and spirometry. The mean unit costs for the various preoperative tests were obtained from the two hospitals participating in the study. To calculate the potential cost savings derived from the appropriate use of preoperative tests, several scenarios were considered. These were characterized by different hypotheses or degrees of fulfillment of a protocol based on scientific knowledge and considered as the gold standard.

RESULTS

In the ideal scenario in which the recommended scientific protocol was fulfilled in 100% of the 16 179 patients with an American Society of Anesthesiologists (ASA) grade of I-II, the economic impact would be notable, since it would free sensitive resources that could be used for other health programs. These figures could amount to approximately 1.02 million euros, without considering the cost of preoperative hospital stay. This figure could increase by up to approximately 2.13 million euros if one day of preoperative hospital stay were included and by up to 3.24 million euros if two days of preoperative hospital stay were included.

CONCLUSIONS

The recent literature review and the results of the questionnaire applied in the CHS indicate that preoperative tests are of greatest benefit to patients and to society if their use is guided by scientific knowledge. In addition, resources can be freed by better selection and utilization of preoperative tests.