OBJECTIVES : To explore the impact of including novel value elements in cost-effectiveness analyses (CEAs) by presenting case studies on human papillomavirus infection (HPV) and early stage Hodgkin’s lymphoma (ESHL).

METHODS : We evaluated the cost-effectiveness (CE) of HPV vaccination strategies using the World Health Organization - Preventable Risk Integrated Model (WHO-PRIME). We evaluated the CE of combined modality therapy, compared to chemotherapy alone, for treatment of adult ESHL using a published simulation. With each model, we compared incremental CE calculated using only health sector impacts (the “base case” scenario) to CE calculated with the incorporation of novel value elements. We identified these novel elements from the Second Panel’s Impact Inventory and from the International Society for Pharmacological Outcomes Research (ISPOR) Special Task Force’s Value Flower, including patient time, unpaid caregiver time and costs, productivity loss, value of hope, real option value, and spillover health effects affecting caregivers.

RESULTS : For vaccination of U.S. girls against HPV before sexual debut vs. no vaccination, the base case CE ratio was $38,334 per disability-adjusted life year (DALY) averted. Including each novel value element made CE progressively more favorable (smaller), with HPV vaccination becoming cost-saving (i.e., having lower costs while averting more DALYs) when we included all novel value elements. For combined modality therapy (CMT) vs. chemotherapy in patients with ESHL, the base case results indicated that CMT was cost-saving. Including all novel value elements made this treatment’s net monetized benefits (the sum of its averted resource costs and the net value of its health impacts) less favorable even as the contribution from CMT’s near-term health outcomes grew. That is because novel value elements also amplified contributions from CMT’s long-term adverse side effects.

CONCLUSIONS : Inclusion of novel value elements can substantially influence CE ratio estimates, although their impact can differ across interventions.