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

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.