Future Costs in Cost-Effectiveness Analyses: Past, Present, Future.

Area of Science:

• Health Economics
• Pharmacoeconomics
• Health Technology Assessment

Background:

• Debate exists on including future costs in cost-effectiveness analyses (CEAs) of health technologies.
• Current CEA practices often exclude future medical and non-medical costs, despite theoretical arguments for inclusion.

Purpose of the Study:

• To review theoretical debates and empirical research on incorporating future costs in CEAs.
• To provide conclusions for current practices regarding the inclusion of future medical and non-medical costs.

Main Methods:

• Literature review of theoretical arguments and empirical studies on future costs in CEAs.
• Analysis of the implications of including future costs from different decision-maker perspectives.

Main Results:

• Inclusion of future medical costs (related and unrelated) is recommended for optimal resource use, irrespective of the decision-maker's perspective.
• Future non-medical costs are relevant from a societal perspective if their benefits are also included; current benefit quantification (e.g., QALYs) may not fully capture these.
• Empirical studies demonstrate the significant impact and feasibility of estimating future costs.

Conclusions:

• Current exclusion of future unrelated medical and non-medical costs in practice, as per some guidelines, may lead to suboptimal resource allocation.
• Further research and standardization are needed for estimating future costs and ensuring comparability of CEA studies.
• Clarification is required on how non-health benefits of non-medical spending are captured in health outcome measures.