OBJECTIVES: The French National Authority for Health (HAS) recommends adopting a collective perspective covering “all individuals or institutions affected by the production of cares” in cost-effectiveness analyses (CEA). In practice, many CEAs are restricted to the healthcare system due to limited evidence and data outside direct medical costs. However, this approach is detrimental to a proper assessment of interventions in disabling diseases associated with compensation services, goods and benefits. We examined the challenges and feasibility of valuing disability-related social benefits (DRSB) in the French setting.

METHODS: We analyzed the scope of DSRB and the available data to include in simulations in the context of HAS guidelines and published efficiency opinions in disabling diseases.

RESULTS: DSRB are numerous and represented an annual spending of over 50Bn€ in 2019, a quarter of social security budget. However, few data are available to value them, mostly consisting of aggregated data, unspecific of disability types, while there is significant heterogeneity between benefits and costs depending on the type of disability, territory and individual recourse to welfare benefits. Thus, valuing DSRB into CEA requires many assumptions to transpose disease and interventions’ effects into allowances and costs. Resulting uncertainty is likely to lead to criticism from HAS, limiting their consideration in the HAS’ opinion. Although these methodological impediments may justify adopting a restricted healthcare system perspective, HAS issued methodological reservations due to lacking DSRB modelling.

CONCLUSIONS: Adequate assessment of interventions with high impact on DSRB following HAS’ guidelines is not feasible due to missing data. The lack of medico-economic value of disability-reducing interventions may represent a barrier to access for these therapies in France. This highlights the need to open access to qualitative DSRB-related data and establish a methodological framework to consider disability reduction in the collective perspective, allowing proper valuation of the benefits of these interventions.