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Costs of Illness in Cost-Effectiveness Analysis

A Review of the Methodology

  • Review Article
  • Cost of Illness in CEA
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Abstract

Summary

Costs of illness are an important input in cost-effectiveness analysis (CEA). Reviews of the literature have found that many CEAs are of low technical quality and fail to take accoum of costs of illness appropriately. The costs of illness and disease averted by an intervention, indirect costs, and medical care costs in added years of life arc topics that present methodological issues and are nOt handled consistently in CEAs.

Costs of illness and discase averted may be estimated by prevalence- or incidence- based methods; the correct conceptual paradigm depends on the nature of the disease. Incidence costs may be estimated by modelling the disease process. or directly from prevalence costs. the choice being determined by the extent and quality of data available. Regardless of the method. in forward-looking CEAs potential technological change must be taken into account so that incidence-based lifetime costs estimated from current treatment practices will not be biased.

Whether to include indirect costs is an important issue. because indirect costs may be large and have a significant impact on the cost-effectiveness ratio. In the pure CEA model. indirect costs are excluded on ethical grounds and 10 prevent incursion of elements of cost-benefit analysis into CEA. The modified CEA model accepts enhanced productivity as an economic benefit made possible by, but distinct from. the health effect of an intervention. Indirect costs are included when appropriate, dependi ng on the perspective of the analysis, the measure of effecti veness. and who bears the costs.

When medical care extends life, expenditures will be incurred in the added years for illness and disease unrelated to the intervention. As with indirect costs. the pure CEA considers unrelated ‘downstream’ costs an indirect consequence of the health benefit of the intervention and excludes them from CEAs with the societal perspective. The modified CEA treats unrelated downstream costs as an economic effect of the change in health due to the intervention and includes them in order to have a more complete accounting of the cost of the intervention.

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References

  1. Hodgson TA, Meiners MR. Cost-of-illness methodology: a gu ide to curren t practi ces and procedures. Milbank Q 1982; 60: 429–62

    CAS  Google Scholar 

  2. Fein R. On measuring economic benefit of health programs. In: Veatch RM, Branson R, editors. Ethics and health policy. Cambridge. MA: Ballinger, 1976: 261–87

    Google Scholar 

  3. Fein R. Economics of mental illness. New York: Basic, 1958

    Book  Google Scholar 

  4. Weisbrod B. Economics of public health. Philadelphia: University of Pennsylvania Press, 1961

    Google Scholar 

  5. Klarman H. Syphilis control programs. In: Dorfman R, editor. Measuring benefits of government investments. Washington, DC: The Brookings Institution, 1965: 367–414

    Google Scholar 

  6. Mushkin SJ. Health as an investment. J Political Economy 1962; 70: 5Pt

    Google Scholar 

  7. Rice DP. Estimating the cost of illness. Health Economic Series No 6. Washington, DC: US Government Priming Office. 1966: Pub. No. 947-6

    Google Scholar 

  8. The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis. Am J Public Health 1980; 70: 1249–60

  9. Harlunian NS, Smart CN, Thompson MS. The incidence and oxonomic costs of major health impairments. Lexington, MA: Lexingtom Books 1981

    Google Scholar 

  10. Hellinger FJ. The lifetime cost of treating a person with HIV. JAMA 1993; 270: 474–8

    Article  PubMed  CAS  Google Scholar 

  11. Hodgson TA. Cigarette smoking and lifetime medical expenditures. Milbank Q 1992; 70: 81–125

    Article  PubMed  CAS  Google Scholar 

  12. Max W, Rice DP, MacKenzie EJ. The lifetime cost of injury. Inquiry 1990; 27: 332–43

    PubMed  CAS  Google Scholar 

  13. Persson U, Silverberg R, Lindgren B, et al. Direct cost of stroke for a Swedish population. lnt J Terhnol Assess Health Care 1990; 6: 125–37

    Article  CAS  Google Scholar 

  14. Winds EH, Hay JW, Gotto Jr AM. Medical Cost of coronary artery disease in the US. Am J Canrdiol 1990; 65: 432–40

    Article  Google Scholar 

  15. Hodgson TA. Annual costs of illness versus lifetime costs of illness and implications of structural change. Drug Information J 1988; 22: 323–41

    Google Scholar 

  16. Drummond ME, Stoddan GL, Torrance Gw. Methods for the economic evaluation of health Care programmes. Oxford: Oxford, 1981

    Google Scholar 

  17. Lua BR, Elixhauser A. Standards for the socioeconomic evaluation of heahh care services. New York: Springer-Verlag, 1990

    Google Scholar 

  18. Thompson MS. Benefit-cost analysis for program evaluation. Beverly Hills, CA: Sage, 1980

    Google Scholar 

  19. Klarman HE, Francis JO, Rosenthal GD. Cost effectiveness analysis applied to the treatment of chronic renal disease. Med Care 1968; 6: 48–54

    Article  Google Scholar 

  20. Weinstein MC. Challenges for cost-effectiveness research. Med Decis Making 1986; 6: 194–8

    Article  PubMed  CAS  Google Scholar 

  21. Weinstein MC. Principles of cost-effective resource allocation in health care organizalions. Int J Technol Assess Health Care 1990; 6: 93–103

    Article  PubMed  CAS  Google Scholar 

  22. Freund DA, Dittus RS. Principles of pharmacoeconomics analysis of drug therapy. PharmacoEconomics 1992; 1: 20–32

    Article  PubMed  CAS  Google Scholar 

  23. Patrick DL, Erickson P. Health status and health policy: quality of life in health care evalualion and resource allocation. New York: Oxford, 1993

    Google Scholar 

  24. Udvarhelyi IS, Colditz GA, Rai A, et al. Cost-effectiveness and cost-benefit analyses in the medical literature. Ann Intern Med 1992; 116: 238–44

    PubMed  CAS  Google Scholar 

  25. Warner KE, Hunon RC. Cost-benefit and cost-effectiveness analysis in health care. Med Care 1980; 18: 1069–84

    Article  PubMed  CAS  Google Scholar 

  26. Drummond MF. Survey of cost-effectiveness and cost-benefit analyses in industrialized countries. World Health Sial Q 1985; 38: 383–401

    CAS  Google Scholar 

  27. Johannesson M, Jonsson B. Cost-effeeciveness analysis of hypertension treament - a review of methodological issues. Health Policy 1991; 19: 55–78

    Article  PubMed  CAS  Google Scholar 

  28. Johannesson M, Junsson B. A review of cost-effectiveness analyses of hypertension treatment. PharmacoEconomics 1992; 1: 250–64

    Article  PubMed  CAS  Google Scholar 

  29. Holliday SM, Faulds D. Hepatitis B vaccine: a pharmacoeconomic evaluation of its use in the prevention of hepatitis B virus infection. PharmacoEconomics 1994; 5: 141–71

    Article  PubMed  CAS  Google Scholar 

  30. Drummond M, Brandt A, Luce B, et al. Standardizing methodologies for oconomic evaluation in health care. Int J Technol Assess Health Care 1993; 9: 26–36

    Article  PubMed  CAS  Google Scholar 

  31. Jöson B. Cost-benefit analysis of hepatitis B vaccination. Postgrad Med J 1987; 63 Suppl. 2: 27–32

    Google Scholar 

  32. Groves EJ. Utilization of short-stay hospitals, US, 1985. Vital and Health Statistics Series No. 91. Washington, DC: US Government Printing Office, 1981: DHHS Pub. No. (PHS)87-1752

    Google Scholar 

  33. Graves EJ. National Hospital Discharge Survey: annual summary 1991. Vital and Health Statistics Series 13, No. 114, Washington, DC: US Government Printing Office. 1993: DHHS Pub. No. (PHS)93-1175

    Google Scholar 

  34. Bennett Jr IL. Technology as a shaping force. Daedalus 1977; 106: 125–33

    Google Scholar 

  35. Chrisp P, Lewis NJW, Milne RJ. Simvaslatin: a pharmacoeconomic evaluation of its cost-effectiveness in hypercholesterolaemia and prevention of coronary heart disease. PharmacoEconomics 1992; 1: 124–45

    Article  PubMed  CAS  Google Scholar 

  36. Goldman L, Weinstein MC, Goldman PA, et al. Cost effectiveness of HMG-CoA reductase inhibition for primary and secondary prevention of coronary heart disease. JAMA 1991; 265: 1145–51

    Article  PubMed  CAS  Google Scholar 

  37. Hjalle K, Lindgren B, Persson U. Cost-effectiveness of simvastatin versus choicstyrmninc-resul1s for Sweden. PharmcoEconomies 1992; 1: 213–6

    Article  Google Scholar 

  38. Ostcr J, Epstein AM. Primary prevention and coronary heart disease: the economic benefits of lowering serum cholesterol. Am J Public Health 1986; 76: 647–56

    Article  Google Scholar 

  39. Oster J, Epstein AM. Cost-effectiveness of antihyperlipemic therapy in the prevention of coronary heart disease - the case of cholestyramine. JAMA 1987; 258: 2381–7

    Article  PubMed  CAS  Google Scholar 

  40. Schulman KA, Kinosian B, Jacobson TA, et al. Reducing high blood choleslerol level with drugs - cOst-effectiveness of pharmacologic management. JAMA 1990; 264: 3025–33

    Article  PubMed  CAS  Google Scholar 

  41. Arevalo JA, Washington AE. Cost-effectiveness of prenatal screening and immunizalion for hepatitis B virus. JAMA 1988; 259: 365–9

    Article  PubMed  CAS  Google Scholar 

  42. Oddone EZ, Cowper PA, Hamillon JD, et al. A cost-effectiveness analysis of hepatitis B vaccine in predialysis patients. Health Serv Res 1993; 28: 97–121

    PubMed  CAS  Google Scholar 

  43. Dao TD. Cost-benefit and cost-effectiveness analysis of drug therapy. Am J Hosp Pharm 1985; 42: 791–802

    PubMed  CAS  Google Scholar 

  44. Koopmanschap MA, Rutten FH. Indirect costs in economic studies: confronting the cunfusion. PharmacoEconomics 1993; 4: 446–54

    Article  PubMed  CAS  Google Scholar 

  45. Drummond MF, Davies LM, Ferris III FL. Assessing the cost and benefits of medical research: the diabetic retinopathy study. Soc Sci Med 1992; 34: 973–81

    Article  PubMed  CAS  Google Scholar 

  46. Ramsey SO, Netttleman MD. Cost-effoctiveness of prophylactic AZT following needleslick injury in health care workers. Med Decis Making 1992; 12: 142–8

    Article  PubMed  CAS  Google Scholar 

  47. Jönson B, Horisbergcr B, Bruguera M, et al. Cost-benefit analysis of hepatitis-B vaccination. Int J Technol Assess Health Care 1991; 7: 379–402

    Article  Google Scholar 

  48. Russell LB. Is prevention better than cure? Washington, DC: The Brookings Institution, 1986

    Google Scholar 

  49. Weinstcin MC. From cost-effectiveness ratios to resource allocation: where to draw the line? In: Sloan FA, editor. Valuing health care-cost, benefits and effectiveness of pharmaceuticals and other medical technologies. New York: Cambridge University Press. In press

  50. Nissincn A, Tuomilchto J, Kottke TE, et al. Cost efectiveness of the North Karelia hypenension program 1972-1977. Med Care 1986; 24: 767–80

    Article  Google Scholar 

  51. Johannesson M, Jönsson B. Economic evaluation in healthcare: is there a role for cost-benefit analysis? Health Policy 1991; 17: 1–23

    Article  PubMed  CAS  Google Scholar 

  52. Kamlet MS. The comparative benefits modding project: a framework for cost-utility analysis of government health care pmgrams. Washington, DC: Department of Health and Human Services, 1992

    Google Scholar 

  53. Torrance GW, Feeny D. Utilities and quality-adjusted life years. Int J Technol Assess Health Care 1989; 5: 559–75

    Article  PubMed  CAS  Google Scholar 

  54. Drummond M, Torrance G, Mason J. Cost-effective league tables: more harm than good? Soc Sci Med 1993; 37: 33–40

    Article  PubMed  CAS  Google Scholar 

  55. Krumholz HM, Pasternak RC, Weinstein MC, et al. Cost effectiveness of thrombolytic therapy with streptokinase in elderly patients with suspected acute myocardial infarction. N Engl J Med 1992; 327 (1): 7–13

    Article  PubMed  CAS  Google Scholar 

  56. Warner KE, Luce BR. Cost-benefit and cost-effectiveness analysis in health care. Ann Arbor, MI: Health Administration Press, 1982

    Google Scholar 

  57. Letsch SW, Lazenby HC, Levil KR, et al. National health expenditures. 1991

    Google Scholar 

  58. US Bureau of the Census. Statistical abstract of the US 1992. 112th edition. Washington, DC: US Government Printing Office, 1992

    Google Scholar 

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  1. Office of Analysis, Epidemiology and Health Promotion, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Rood, Hyattsville, Maryland, 20782, USA

    Thomas A. Hodgson

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Hodgson, T.A. Costs of Illness in Cost-Effectiveness Analysis. Pharmacoeconomics 6, 536–552 (1994). https://doi.org/10.2165/00019053-199406060-00007

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