The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

TY - JOUR

T1 - The impact of healthcare costs in the last year of life and in all life years gained on the cost-effectiveness of cancer screening

AU - de Kok, I M C M

AU - Polder, J J

AU - Habbema, J D F

AU - Berkers, L-M

AU - Meerding, W J

AU - Rebolj, M

AU - van Ballegooijen, M

N1 - Keywords: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Child; Confidence Intervals; Cost of Illness; Cost-Benefit Analysis; Female; Humans; Male; Mass Screening; Middle Aged; Models, Economic; Neoplasms; Netherlands

PY - 2009

Y1 - 2009

N2 - It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998-1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by 4040 euro in women, and by 4100 euro in men. Of these, 660 euro in women, and 890 euro in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately 4000 euro. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications.

AB - It is under debate whether healthcare costs related to death and in life years gained (LysG) due to life saving interventions should be included in economic evaluations. We estimated the impact of including these costs on cost-effectiveness of cancer screening. We obtained health insurance, home care, nursing homes, and mortality data for 2.1 million inhabitants in the Netherlands in 1998-1999. Costs related to death were approximated by the healthcare costs in the last year of life (LastYL), by cause and age of death. Costs in LYsG were estimated by calculating the healthcare costs in any life year. We calculated the change in cost-effectiveness ratios (CERs) if unrelated healthcare costs in the LastYL or in LYsG would be included. Costs in the LastYL were on average 33% higher for persons dying from cancer than from any cause. Including costs in LysG increased the CER by 4040 euro in women, and by 4100 euro in men. Of these, 660 euro in women, and 890 euro in men, were costs in the LastYL. Including unrelated healthcare costs in the LastYL or in LYsG will change the comparative cost-effectiveness of healthcare programmes. The CERs of cancer screening programmes will clearly increase, with approximately 4000 euro. However, because of the favourable CER's, including unrelated healthcare costs will in general have limited policy implications.

U2 - 10.1038/sj.bjc.6605018

DO - 10.1038/sj.bjc.6605018

M3 - Journal article

C2 - 19367281

SN - 0007-0920

VL - 100

SP - 1240

EP - 1244

JO - The British journal of cancer. Supplement

JF - The British journal of cancer. Supplement

IS - 8

ER -