What Are the Hidden Costs in Health Care Decisions?

Over the past decade, health economists have been paying more attention to the bigger picture when evaluating the value of medical treatments. A recent study looked at nearly 8, 000 cost-effectiveness analyses (CEAs) from 2013 to 2023. These studies compare the costs and benefits of different health interventions. The focus here was on whether these analyses included broader societal costs beyond just medical expenses. Societal costs cover things like lost productivity, transportation, caregiver time, and patient time. These factors can add up and significantly impact the overall cost-effectiveness of a treatment. The study found that the inclusion of these costs has been slowly increasing, from 19% of studies in 2013 to 28% in 2023. However, this is still a minority of studies. The study also found big differences in how often societal costs are included depending on where the study was done. For example, studies from Scandinavian countries and the Netherlands were much more likely to include these costs, while studies from Canada, Australia, and the UK were less likely to do so. This variation suggests that cultural, economic, and policy differences play a big role in how health care costs are evaluated. Certain types of studies were also more likely to include societal costs. For instance, studies on mental health disorders and immunization were more likely to factor in these broader costs. Similarly, studies focusing on children were more likely to include societal costs, while studies on the elderly were less likely to do so. This could be because the economic impact of treating children is often felt more broadly in society. When societal costs were included, they often changed the overall cost-effectiveness of the treatment. In 72% of cases, including these costs lowered the overall cost, making the treatment seem more valuable. In 74% of cases, it also lowered the incremental cost-effectiveness ratio (ICER), which is a key measure used to determine if a treatment is worth the cost. This shows that ignoring these costs can lead to an incomplete picture of a treatment's true value. The study highlights the importance of considering societal costs in health care evaluations. However, it also notes that these costs should be included thoughtfully, based on their relevance and the potential to influence decision-making. Not all costs are equal, and some may not be as important in certain contexts. By carefully considering these factors, health economists can make more accurate and fair assessments of the value of different health interventions.