The Inclusion of Spillover Effects in Economic Evaluations: Not an Optional Extra

I use the word ‘optimization’ rather than maximization to allow weighting of health gains, for instance to favor gains at the end of life, in young people or patients in poor health states. Such weights can be seen as reflecting differential social values of health gains. I emphasize that analogous to difficulties in specifying a social welfare function, it may be difficult to specify a full ‘social health value function’.

Recently, it was, for instance, used to argue against the inclusion of medical costs in gained life-years [22], apparently largely motivated by the outcomes of inclusion (in one particular case). But again, ignoring these costs is inconsistent with the aims and methods of economic evaluations as it ignores real (health) opportunity costs of these expenditures [23]. It thus makes life-prolonging interventions seem more cost effective than they actually are and relatively more cost effective than quality-of-life-improving interventions. Is that (necessarily) fair, also for those people who will receive less care as a consequence? I would argue that ignoring them is not the appropriate answer to the problem, not consistent with the overall decision goals and methods, nor fairer as a rule! Deliberative consideration of these costs and their consequences is warranted.