Abstract
BackgroundVariation exists in the resource categories included in economic evaluations, and National Institute for Health and Care Excellence (NICE) guidance suggests the inclusion only of costs related to the index condition or intervention. However, there is a growing consensus that all healthcare costs should be included in economic evaluations for Health Technology Assessments (HTAs), particularly those related to extended years of life.Objective and MethodsWe aimed to quantify the impact of a range of cost categories on the adoption decision about a hypothetical intervention, and uncertainty around that decision, for stable coronary artery disease (SCAD) based on a dataset comprising 94,966 patients. Three costing scenarios were considered: coronary heart disease (CHD) costs only, cardiovascular disease (CVD) costs and all costs. The first two illustrate different interpretations of what might be regarded as related costs.ResultsEmploying a 20-year time horizon, the highest mean expected incremental cost was when all costs were included (£2468) and the lowest when CVD costs only were included (£2377). The probability of the treatment being cost effective, estimating health opportunity costs using a ratio of £30,000 per quality-adjusted life-year (QALY), was different for each of the CHD (70%) costs, CVD costs (73%) and all costs (56%) scenarios. The results concern a hypothetical intervention and are illustrative only, as such they cannot necessarily be generalised to all interventions and diseases.ConclusionsCost categories included in an economic evaluation of SCAD impact on estimates of both cost effectiveness and decision uncertainty. With an aging and co-morbid population, the inclusion of all healthcare costs may have important ramifications for the selection of healthcare provision on economic grounds.Electronic supplementary materialThe online version of this article (10.1007/s41669-018-0068-1) contains supplementary material, which is available to authorized users.
Highlights
Interventions in patients with coronary heart disease (CHD) or at risk of CHD present significant costs to the UK National Health Service (NHS), may reduce the risks of CHD events such as acute myocardial infarction (MI), may reduce the risk of other health events and can potentially improve survival patients [1, 2]
Background Variation exists in the resource categories included in economic evaluations, and National Institute for Health and Care Excellence (NICE) guidance suggests the inclusion only of costs related to the index condition or intervention
Cost categories included in an economic evaluation of stable coronary artery disease (SCAD) impact on estimates of both cost effectiveness and decision uncertainty
Summary
Interventions in patients with coronary heart disease (CHD) or at risk of CHD present significant costs to the UK National Health Service (NHS), may reduce the risks of CHD events such as acute myocardial infarction (MI), may reduce the risk of other (non-CHD) health events and can potentially improve survival patients [1, 2]. There is extensive debate, around what types of costs should be included in estimating the incremental costs of a new intervention [6, 7], and what costs are included can have material impacts on the expected cost effectiveness and the associated uncertainty. This can affect the decisions reached by policy makers, e.g. whether to approve or reject the new intervention unconditionally, or whether to recommend an alternative coverage decision such as coverage with evidence development [8–10]. The results concern a hypothetical intervention and are illustrative only, as such they cannot necessarily be generalised to all interventions and diseases
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