A Review of Indirect Costs Within Economic Appraisals in France
Author(s)
Romane Gerrer-Soustiel, Msc1, Paul Casabianca, PharmD2, FRANCOIS-EMERY COTTE, PhD2.
1Universite Paris-Saclay, Paris, France, 2Bristol Myers Squibb, Rueil Malmaison, France.
1Universite Paris-Saclay, Paris, France, 2Bristol Myers Squibb, Rueil Malmaison, France.
OBJECTIVES: While the French economic HTA body (CEESP) recommends using a collective perspective for economic appraisal (EA), implementing indirect costs (IC) is not accepted in reference base case analyses (BCA). This study explores how IC are considered by manufacturers and CEESP.
METHODS: A review of all EA published through April 2025 was conducted to identify mentions of IC and productivity loss (PL). EA’s contextual data, results, and references to IC were compiled for analysis.
RESULTS: Out of 260 EA reviewed, IC are mentioned in 41 but detailed in 27 only. Out of 27, 85% concerned pharmaceuticals. Most concerned neurology (26%), dermatology (19%), or hematology (19%). While some BCA included IC (7%), none received CEESP validation. IC appeared in undefined sensitivity (48%) and scenario (30%) analyses. While over half included IC in cost-effectiveness analyses, 7% mentioned them in budget-impact analyses only, and 30% in both. The average starting age within model was 35 years, 11% addressing pediatric population. All EA cited PL as the primary IC measure, focusing mainly on the patient (93%) or both patients and caregivers (7%), one including parent’s hotel stays. When valuation was detailed by CEESP (n=19), PL was assessed using French Gross Domestic Product per worked day (79%) or average healthcare indemnities per sick leave day (21%). The median cost assigned to one worked day was €204. Incorporating IC into sensitivity analyses improved incremental cost-effectiveness ratio in 11 out of 12 EA with a magnitude ranging from +0.3% to -95.5%, while two therapeutic strategies became dominant.
CONCLUSIONS: Per CEESP guidelines, even though they have a significant impact on a product’s cost-effectiveness, IC have never been accepted in reference BCA. However, their valuation is relatively consistent, with per capita measures being common and exhibiting similar values. Thus, current BCA do not fully capture the product value and tend to be conservative.
METHODS: A review of all EA published through April 2025 was conducted to identify mentions of IC and productivity loss (PL). EA’s contextual data, results, and references to IC were compiled for analysis.
RESULTS: Out of 260 EA reviewed, IC are mentioned in 41 but detailed in 27 only. Out of 27, 85% concerned pharmaceuticals. Most concerned neurology (26%), dermatology (19%), or hematology (19%). While some BCA included IC (7%), none received CEESP validation. IC appeared in undefined sensitivity (48%) and scenario (30%) analyses. While over half included IC in cost-effectiveness analyses, 7% mentioned them in budget-impact analyses only, and 30% in both. The average starting age within model was 35 years, 11% addressing pediatric population. All EA cited PL as the primary IC measure, focusing mainly on the patient (93%) or both patients and caregivers (7%), one including parent’s hotel stays. When valuation was detailed by CEESP (n=19), PL was assessed using French Gross Domestic Product per worked day (79%) or average healthcare indemnities per sick leave day (21%). The median cost assigned to one worked day was €204. Incorporating IC into sensitivity analyses improved incremental cost-effectiveness ratio in 11 out of 12 EA with a magnitude ranging from +0.3% to -95.5%, while two therapeutic strategies became dominant.
CONCLUSIONS: Per CEESP guidelines, even though they have a significant impact on a product’s cost-effectiveness, IC have never been accepted in reference BCA. However, their valuation is relatively consistent, with per capita measures being common and exhibiting similar values. Thus, current BCA do not fully capture the product value and tend to be conservative.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE31
Topic
Economic Evaluation, Health Technology Assessment
Topic Subcategory
Work & Home Productivity - Indirect Costs
Disease
No Additional Disease & Conditions/Specialized Treatment Areas