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The Impact of Broader Value Elements on Cost-Effectiveness Analysis: Two Case Studies.

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Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
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Including broader value elements in cost-effectiveness analyses significantly impacts results. For HPV vaccination, incorporating productivity costs made it cost-saving, demonstrating the value of wider economic impacts.

Keywords:
Second Panelbroader value elementsearly-stage Hodgkin's lymphomahuman papillomavirus infectionincremental cost-effective ratiosoptional valuepatient and caregiver timeproductivity costsspillover health effectsvalue flowervalue of hope

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Area of Science:

  • Health Economics
  • Pharmacoeconomics
  • Public Health Policy

Background:

  • Cost-effectiveness analysis (CEA) traditionally focuses on direct healthcare costs and outcomes.
  • Broader societal and economic impacts, such as productivity and patient time, are often excluded.
  • Incorporating these wider value elements can provide a more comprehensive assessment of intervention value.

Purpose of the Study:

  • To explore the impact of including broader value elements in cost-effectiveness analyses.
  • To present two case studies evaluating human papillomavirus (HPV) infection and early-stage Hodgkin's lymphoma (ESHL) interventions.
  • To compare standard CEA results with those incorporating broader value considerations.

Main Methods:

  • Identified broader value elements from established frameworks (Impact Inventory, value flower).
  • Evaluated cost-effectiveness of HPV vaccination vs. no vaccination and combined modality therapy (CMT) vs. chemotherapy alone for ESHL using simulation models.
  • Compared incremental cost-effectiveness ratios (ICERs) under health sector impacts only versus those including broader value elements.

Main Results:

  • For HPV vaccination, the base-case ICER was $38,334 per disability-adjusted life-year (DALY) averted. Including productivity costs made HPV vaccination cost-saving.
  • For ESHL, CMT was cost-saving in the base-case analysis.
  • Incorporating all broader elements made CMT's net monetary benefits less favorable, despite increased near-term health benefits.

Conclusions:

  • Broader value elements can significantly alter cost-effectiveness ratios.
  • The direction and magnitude of impact vary depending on the intervention and disease context.
  • A comprehensive approach considering wider economic and societal impacts is crucial for accurate CEA.