The Impact of Broader Value Elements on Cost-Effectiveness Analysis: Two Case Studies |
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| Institution: | 1. Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA;2. Department of Medicine, Tufts University School of Medicine, Boston, MA, USA;1. Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia;2. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;3. Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia;4. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia;5. Department of Allergy and Immunology, The Royal Children’s Hospital, Melbourne, Victoria, Australia;1. Centre for Health Economics, University of York, York, England, UK;2. Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina;3. Kalam Institute of Health Technology, Andhra Pradesh, India;4. Institute for Clinical and Economic Review, Boston, MA, USA;5. University of Utah, Salt Lake City, UT, USA;6. Monash University, Selangor, Malaysia;7. Fudan University, Shanghai, China;8. Ministry of Health, Mexico;9. COEUS Consulting Group, Devon, PA, USA;10. Ministry of Trade, Industry and Tourism, Colombia;11. Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada;12. Tufts Medical Center, Boston, MA, USA;13. RTI Health Solutions, Ann Arbor, MI, USA;14. Bocconi University, Milano, Italy;15. Premera Blue Cross, Mountlake Terrace, WA, USA;16. Kaiser Permanente Washington Health Research Centre, Seattle, WA, USA;17. IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA;1. Viatris, Canonsburg, PA, USA;2. NERA Economic Consulting, Philadelphia, PA, USA;3. Pfizer, Inc, Collegeville, PA, USA;1. EsCHER, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands;2. Department of Economics, Universidad de Navarra, Pamplona, Spain;1. Office of Health Economics, London, England, UK;2. Biogen, Maidenhead, England, UK |
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| Abstract: | ObjectivesThis study aimed to explore the impact of including broader value elements in cost-effectiveness analyses by presenting 2 case studies, one on human papillomavirus (HPV) infection and one on early-stage Hodgkin’s lymphoma (ESHL).MethodsWe identified broader value elements (eg, patient and caregiver time, spillover health effects, productivity) from the Second Panel’s Impact Inventory and the ISPOR Special Task Force’s value flower. We then evaluated the cost-effectiveness of HPV vaccination versus no vaccination (case 1) and combined modality therapy (CMT) versus chemotherapy alone for treatment of adult ESHL (case 2) using published simulation models. For each case study, we compared incremental cost-effectiveness ratios considering health sector impacts only (the “base-case” scenario) with incremental cost-effectiveness ratios incorporating broader value elements.ResultsFor vaccination of US girls against HPV before sexual debut versus no vaccination, the base-case result was $38 334 per disability-adjusted life-year averted. Including each broader value element made cost-effectiveness progressively more favorable, with HPV vaccination becoming cost-saving (ie, reducing costs and averting more disability-adjusted life-years) when the analysis incorporated productivity costs. For CMT versus chemotherapy alone in patients with ESHL, the base-case result indicated that CMT was cost-saving. Including all elements made this treatment’s net monetary benefits (the sum of its averted resource costs and the net value of its health impacts) less favorable, even as the contribution from CMT’s near-term health benefits grew.ConclusionsIncluding broader value elements can substantially influence cost-effectiveness ratios, although the direction and the magnitude of their impact can differ across interventions and disease context. |
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| Keywords: | broader value elements early-stage Hodgkin's lymphoma human papillomavirus infection incremental cost-effective ratios optional value patient and caregiver time productivity costs Second Panel spillover health effects value flower value of hope |
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