HOW DOES FAILURE TO ACCOUNT FOR BEREAVEMENT COSTS AFFECT ECONOMIC EVALUATIONS?
Author(s)
Emmanuel F. Drabo, PhD1, Jack Chapel, PhD2.
1Associate Professor, Erasmus School of Health Policy & Management, Rotterdam, Netherlands, 2USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.
1Associate Professor, Erasmus School of Health Policy & Management, Rotterdam, Netherlands, 2USC Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.
OBJECTIVES: Cost-effectiveness analyses (CEAs) rarely account for the health and economic consequences of bereavement, potentially underestimating the value of interventions that affect mortality. This study examines the conceptual basis for including bereavement spillovers in CEA, addresses key methodological challenges, and estimates the potential bias resulting from their exclusion.
METHODS: We assess four core methodological issues relevant to incorporating bereavement spillovers into applied economic evaluation: (1) measurement of changes in utility and costs associated with bereavement; (2) application of multiplier approaches to capture downstream spillover effects of mortality; (3) the influence of analytic perspective (societal versus payer) on inclusion decisions; and (4) attribution of productivity losses and direct healthcare costs arising from bereavement. We situate bereavement effects within established welfare-economic theory underpinning cost-utility analysis. An empirical illustration is provided using a dynamic microsimulation of a U.S. cohort aged ≥50 years, estimating lifetime health and economic consequences of spousal bereavement. We further simulate hypothetical interventions affecting mortality to evaluate the extent of bias introduced when bereavement spillovers are omitted.
RESULTS: Results from our microsimulation indicate that spousal bereavement is associated with approximately 0.4 fewer life-years and around $35,000 in discounted lifetime costs per widowed individual, driven primarily by reduced quality of life and increased medical expenditures. Scenario analyses suggest that excluding bereavement-related spillovers can materially bias the incremental cost-effectiveness ratio and incremental net monetary benefit, particularly for interventions targeting older populations or high-mortality conditions.
CONCLUSIONS: Bereavement-related health and economic consequences are theoretically consistent with welfare-economic foundations of CEA and are empirically non-trivial. Their systematic exclusion likely leads to biased estimates of value in health economic evaluations. We provide methodological guidance for incorporating bereavement spillovers and highlight implications for future applied work and decision-making.
METHODS: We assess four core methodological issues relevant to incorporating bereavement spillovers into applied economic evaluation: (1) measurement of changes in utility and costs associated with bereavement; (2) application of multiplier approaches to capture downstream spillover effects of mortality; (3) the influence of analytic perspective (societal versus payer) on inclusion decisions; and (4) attribution of productivity losses and direct healthcare costs arising from bereavement. We situate bereavement effects within established welfare-economic theory underpinning cost-utility analysis. An empirical illustration is provided using a dynamic microsimulation of a U.S. cohort aged ≥50 years, estimating lifetime health and economic consequences of spousal bereavement. We further simulate hypothetical interventions affecting mortality to evaluate the extent of bias introduced when bereavement spillovers are omitted.
RESULTS: Results from our microsimulation indicate that spousal bereavement is associated with approximately 0.4 fewer life-years and around $35,000 in discounted lifetime costs per widowed individual, driven primarily by reduced quality of life and increased medical expenditures. Scenario analyses suggest that excluding bereavement-related spillovers can materially bias the incremental cost-effectiveness ratio and incremental net monetary benefit, particularly for interventions targeting older populations or high-mortality conditions.
CONCLUSIONS: Bereavement-related health and economic consequences are theoretically consistent with welfare-economic foundations of CEA and are empirically non-trivial. Their systematic exclusion likely leads to biased estimates of value in health economic evaluations. We provide methodological guidance for incorporating bereavement spillovers and highlight implications for future applied work and decision-making.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE34
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Novel & Social Elements of Value
Disease
Geriatrics, No Additional Disease & Conditions/Specialized Treatment Areas