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Endogenous patient responses and the consistency principle in cost-effectiveness analysis

Liqun Liu1, Andrew J Rettenmaier1, Thomas R Saving1

  • 1Texas A&M University, College Station, TX (LL, AJR, TRS)

Medical Decision Making : an International Journal of the Society for Medical Decision Making
|November 22, 2011
PubMed

Insights

This study clarifies the consistency principle in cost-effectiveness analysis (CEA). Including or excluding costs and benefits of patient responses does not change CEA results, but including survival consumption and earnings is recommended.

Area of Science:

  • Health Economics
  • Medical Decision Making
  • Pharmacoeconomics

Background:

  • Medical interventions have direct costs and health benefits, but also indirect financial and health impacts.
  • Determining which costs and benefits to include in cost-effectiveness analysis (CEA) is crucial.
  • The consistency principle mandates including or excluding both costs and utility benefits of a change.

Purpose of the Study:

  • To address the consistency principle in CEA by distinguishing exogenous and endogenous changes.
  • To determine how to choose between exclusion/inclusion rules for CEA.
  • To clarify the treatment of consumption costs and earnings in CEA.

Main Methods:

  • Distinguishing exogenous (intervention-driven) and endogenous (patient response) changes.
  • Utilizing a lifetime utility maximization framework.
  • Analyzing the impact of inclusion/exclusion rules on CEA outcomes.

Main Results:

  • Excluding or including both costs and utility benefits of endogenous changes does not affect CEA results.
  • Welfare maximization supports including consumption costs and earnings in CEA.
  • The study provides guidance on applying the consistency principle.

Conclusions:

  • The consistency principle in CEA is clarified, particularly regarding endogenous changes.
  • Including consumption costs and earnings in CEA aligns with welfare maximization.
  • This research aids in more accurate and comprehensive economic evaluations of medical interventions.

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