SHOULD COST-EFFECTIVENESS ANALYSIS INCLUDE THE COST OF CONSUMPTION ACTIVITIES? AN EMPIRICAL INVESTIGATION

OBJECTIVES There has been a debate on whether cost-effectiveness analysis should consider the cost of consumption and leisure time activities when using the quality-adjusted life year as a measure of health outcome under a societal perspective. The purpose of this study was to investigate whether the effects of ill health on consumptive activities are spontaneously considered in a health state valuation exercise and how much this matters. METHODS The survey enrolled patients with inflammatory bowel disease in Germany (n = 104). Patients were randomized to explicit and no explicit instruction for the consideration of consumption and leisure effects in a time trade-off (TTO) exercise. RESULTS Explicit instruction to consider non-health-related utility in TTO exercises did not influence TTO scores. However, spontaneous consideration of non-health-related utility in patients without explicit instruction (60% of respondents) led to significantly lower TTO scores. CONCLUSIONS Results suggest an inclusion of consumption costs in the numerator of the cost-effectiveness ratio, at least for those respondents who spontaneously consider non-health-related utility from treatment. Given the importance of this question for the conduct of cost-effectiveness analysis in health care, confirmation in additional studies that are conducted outside Germany and consider other health-state valuation techniques and diseases is recommended.