, Volume 37, Issue 4, pp 457–460 | Cite as

Expanding the Scope of Costs and Benefits for Economic Evaluations in Health: Some Words of Caution

  • Christopher McCabeEmail author

What is the scope and purpose of economic evaluation?

Discussions regarding the appropriate scope of costs and benefits for inclusion in economic evaluation in healthcare have been an important strand in the literature for much of the last two decades. Almost from the beginning of the use of cost-effectiveness analysis in healthcare, there have been discussions regarding whether productivity costs should be included and—if so—how. Relatively quickly, the discussions moved on to whether so-called unrelated medical care costs should be included, which in turn was extended to consideration of future non-medical costs. Subsequently, attention shifted to capturing the quality-of-life effects of therapies on carers and then, more broadly, on members of the family/household. This discussion developed into ‘spillover effects’—the impacts of interventions on members of the household of the individual receiving therapy. Most recently, the Second Panel on Cost Effectiveness in Health and Medicine...


Compliance with Ethical Standards


No sources of funding were used to prepare this commentary.

Conflict of interest

Christopher McCabe has no conflicts of interest that are directly relevant to the content of this commentary.


  1. 1.
    Koopmanschap MA, Rutten FFH, van Ineveld BM, van Roijen L. The friction cost method formeasuring indirect costs of disease. J Health Econ. 1995;14:171–89.Google Scholar
  2. 2.
    Brouwer WBF, Koopsmanschap MA, Rutten FH. Productivity costs in cost effectiveness analysis: numerator or denominator? A further discussion. Health Econ. 1997;6:511–4.Google Scholar
  3. 3.
    Dixon S, Walker M, Salek S. Incorporating carer effects into economic evaluation. PharmacoEconomics. 2006;24(1):43–53.Google Scholar
  4. 4.
    Brouwer WBF. Too important to ignore: informal care givers and significant others. PharmacoEconomics. 2006;24(1):39–41.Google Scholar
  5. 5.
    Rappange DR, van Baal PHM, van Exel NJA, Feenstra TL, Rutten FFH, Brouwer WBF. Unrelated medical costs in life years gained: should they be included in economic evaluations of health care interventions? PharmacoEconomics. 2008;26(10):815–6.Google Scholar
  6. 6.
    Bobinac A, Van Exel J, Rutten F, Brouwer W. Caring for and caring about: disentangling the caregiving effect and the family effect. J Health Econ. 2010;29:549–56.Google Scholar
  7. 7.
    Wittenberg E, Prosser L. Disutility of Illness for caregivers and families: a systematic review of the literature. PharmacoEconomics. 2013;31(6):489–500.PubMedCentralGoogle Scholar
  8. 8.
    Sanders GD, Neumann PJ, Basu A, et al. Recommendations for the conduct, methodological practices, and reporting of cost effectiveness analyses: Second panel on cost effectiveness in medicine and health. JAMA. 2016;316(10):1093–103.Google Scholar
  9. 9.
    Canadian Agency for Drugs and Technology in Health Care Common Drug Review. Accessed 31 July 2018.
  10. 10.
  11. 11.
    Australian Government Department of Health. Pharmaceutical Benefits Advisory Committee. Accessed 31 July 2018.
  12. 12.
    Paulden M, O’Mahoney J, McCabe C. Determinants of change in the cost effectiveness threshold. Med Decis Making. 2017;37:264–76.Google Scholar
  13. 13.
    Daniels N, Sabin J. Limits to health care: fair procedures, democratic deliberations and the legitimacy problem for insurers. Philos Public Aff. 1997;26(4):303–50.Google Scholar
  14. 14.
    Tudor-Hart J. The inverse care law. Lancet. 1971;297:405–12.Google Scholar
  15. 15.
    Charles G, Stainton T, Marshall S. Young carers in Canada: the hidden costs and benefits of young caregiving. Vanier Institute of the Family, 2012 Vancouver. Accessed 30 July 2018.
  16. 16.
    Cookson R, Mirelman AJ, Griffin S, et al. Using cost effectiveness analysis to address health equity concerns. Value Health. 2017;20(2):206–12.PubMedCentralGoogle Scholar
  17. 17.
    Lavalle TA, Wittenberg E, Lamarand K, Prosser LA. Variation in the spillover effects of illness on parents, spouses and children of the chronically ill. Appl Health Econ Health Policy. 2014;12(2):117–24.Google Scholar
  18. 18.
    Brouwer W. The inclusion of spillover effects in economic evaluation: not an optional extra. PharmacoEconomics. 2018. Google Scholar
  19. 19.
    Vallejo-Torres L, García-Lorenzo B, Serrano-Aguilar P. Estimating a cost-effectiveness threshold for the Spanish NHS. Health Econ. 2017. Scholar
  20. 20.
    Edney LC, Haji Ali Afzali H, Cheng TC, Karnon J. Estimating the reference incremental cost-effectiveness ratio for the Australian health system. Pharmacoeconomics. 2017. (accessed 30 July 2018).Google Scholar
  21. 21.
    Claxton K, Martin S, Soares M, Rice N, Spackman E, Hinde S, et al. Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold. Health Technol Assess. 2015;19:1–503 (v–vi).PubMedCentralGoogle Scholar
  22. 22.
    Lomas J, Claxton K, Martin S, Soares M. Resolving the “Cost-Effective but Unaffordable” Paradox: estimating the health opportunity costs of nonmarginal budget impacts. Value Health. 2018. (accessed 31 July 2018).Google Scholar
  23. 23.
    Global Genes: FDA Orphan Drug Approvals 2018. Accessed 31 July 2018.
  24. 24.
    Ebied AM, Cooper-deHoff RM. 2017 Banner Year for Drug Approvals. Am Med J. 2018. Accessed 31st July 2018 (in press).
  25. 25.
    Al-Janabi H, van Exel J, Brouwer W, Coast J. A framework for including family health spillovers in economic evaluation. Med Decis Mak. 2016;36(2):176–86.Google Scholar
  26. 26.
    Claxton K, Sculpher M, Palmer S, Culyer AJ. Causes for concern: is NICE failing to uphold its responsibilities to all NHS patients? Health Econ. 2015;24(1):1–7.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Institute of Health EconomicsEdmontonCanada

Personalised recommendations