The Authors’ Reply to van Baal et al.: “Pharmacoeconomic Guidelines Should Prescribe Inclusion of Indirect Medical Costs! A Response to Grima et al.”

Abstract

In their response to our paper on unrelated medical costs [1], van Baal et al. [2] confirm that our paper identifies inherent problems with many national pharmacoeconomic guidelines regarding the consideration of ‘unrelated’ medical costs. In their article, the authors do not offer an opinion on the interpretation of unrelated healthcare costs as they relate to our dialysis example; instead, they conclude that the only logical solution is to change pharmacoeconomic guidelines to include all medical costs, ‘‘whether they are ‘related’ or ‘unrelated’, ‘direct’ or ‘indirect’’’ [2]. Although we are pleased that our article has contributed to the ongoing debate over the appropriateness of excluding unrelated future health costs, we suggest that such theoretical debates must be considered ‘unrelated’ or at least tangential to the objective of our original paper [1]. The objective of our paper was to determine the appropriate handling of dialysis costs in economic analyses of therapies that may extend the life of a dialysis patient, but are not meant to replace or modify the need for chronic, expensive dialysis treatments—given existing guidelines. It is argued by van Baal et al. [2] that excluding dialysis costs ignores the real opportunity costs of prolonging the lives of dialysis patients. We do not disagree that improved survival of high-cost dialysis patients represents a real opportunity cost to the healthcare system; however, exclusion of such costs in our example is entirely consistent with current pharmacoeconomic guidelines and clinical practice. As such, it provides cost-effectiveness ratios that are most comparable to other products considered for reimbursement. In our paper [1], we discuss the following: