Future Offspring Costs in Economic Evaluation

Area of Science:

• Health Economics
• Population Ethics
• Health Technology Assessment (HTA)

Background:

• Current economic evaluation guidelines recommend including all future costs.
• A significant dimension of future costs, related to offspring, is systematically neglected.
• Healthcare interventions can influence patient fertility and future offspring health, incurring substantial costs.

Purpose of the Study:

• To highlight the neglect of future offspring costs in economic evaluations.
• To propose a framework for including relevant future offspring costs in Health Technology Assessment (HTA).
• To address the ethical and methodological challenges of incorporating these costs.

Main Methods:

• Analysis of economic evaluation guidelines and their implications for future costs.
• Application of the population ethics concept of necessitarianism.
• Distinguishing between costs associated with 'necessary' versus 'potential' future lives.

Main Results:

• Future offspring costs can be substantial and vary across interventions and demographics.
• Systematic inclusion of all future offspring costs presents significant methodological problems.
• Applying necessitarianism allows exclusion of costs from 'potential' lives, avoiding skewed outcomes.

Conclusions:

• Future generations represent a substantial gap in current Health Technology Assessment (HTA) methodology.
• The proposed approach using necessitarianism offers a pragmatic way to account for necessary future costs.
• Further discussion is needed to refine HTA methodology regarding the economic implications for future generations.