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When Do Published Cost-Effectiveness Analyses Include Societal Costs? An Empirical Analysis, 2013-2023.

Divya Patil1, Bengt Liljas2, Peter J Neumann1

  • 1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.

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Summary
This summary is machine-generated.

Societal costs are increasingly included in cost-effectiveness analyses (CEAs), but remain infrequent. Their inclusion significantly impacts cost-effectiveness ratios, improving value assessments when guided by relevance and evidence.

Keywords:
cost-effectiveness analysissocietal costssocietal perspective

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Area of Science:

  • Health Economics
  • Decision Science

Background:

  • Societal costs, encompassing productivity, transportation, and caregiver time, are crucial for comprehensive health economic evaluations.
  • Previous analyses have highlighted the underrepresentation of societal costs in cost-effectiveness analyses (CEAs).

Purpose of the Study:

  • To track trends in the inclusion of societal costs in CEAs from 2013 to 2023.
  • To identify factors influencing the inclusion of societal costs.
  • To assess the impact of societal costs on incremental costs and incremental cost-effectiveness ratios (ICERs).

Main Methods:

  • Analysis of 7,800 CEAs from the Tufts Medical Center CEA registry (2013-2023).
  • Evaluation of societal cost inclusion based on study characteristics.
  • Multivariate logistic regression to determine associations between study features and societal cost inclusion.
  • Assessment of the impact of societal costs on incremental costs and ICERs for studies with societal perspectives.

Main Results:

  • Inclusion of societal costs in CEAs rose from 19% to 28% between 2013 and 2023.
  • Productivity, transportation, and caregiver time were the most commonly reported societal cost components.
  • Higher odds of inclusion were observed in analyses from Scandinavian countries and the Netherlands, and for mental health and immunization studies.
  • Inclusion of societal costs decreased incremental costs in 72% of studies and decreased ICERs in 74% of studies, sometimes crossing cost-effectiveness thresholds.

Conclusions:

  • Despite a modest increase, societal costs are underutilized in CEAs, with significant geographic, disease-specific, and population-based variations.
  • Incorporating societal costs can enhance the value assessment of health interventions.
  • The inclusion of societal costs should be context-dependent, guided by relevance, available evidence, and decision-making needs.