Setting the Boundaries for Economic Evaluation- Investigating Time Horizon and Family Effects in the Case of Postnatal Depression

May 1, 2018, 00:00
10.1016/j.jval.2017.10.016
https://www.valueinhealthjournal.com/article/S1098-3015(17)33625-2/fulltext
Title : Setting the Boundaries for Economic Evaluation- Investigating Time Horizon and Family Effects in the Case of Postnatal Depression
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(17)33625-2&doi=10.1016/j.jval.2017.10.016
First page : 573
Section Title : METHODOLOGY
Open access? : No
Section Order : 12

Objectives

This study investigates the impact of varying the boundaries of economic evaluation: time horizon and inclusion of family effects. The context is postnatal mental health, where although advocates for investment often include longer-term and family problems in describing the burden of postnatal depression, economic evaluations are usually limited to mothers’ effects with a relatively short time horizon. This discrepancy may lead to suboptimal allocation of healthcare resources.

Methods

The question of whether such boundary extensions could make a difference to decision-making is explored using decision analytic models, populated with data from the literature, to estimate the cost-effectiveness of a hypothetical preventive intervention under alternate boundary-setting approaches.

Results

The results suggest that broader boundaries, particularly extension of the time horizon, could make substantial differences to estimated cost-effectiveness. Inclusion of family effects without extension of the time horizon had little impact, but where a longer time horizon was used, family effects could make a significant difference to the conclusions drawn from cost-effectiveness analysis.

Conclusions

Considerations in applying broader boundaries include the substantial resource requirements for evaluation, potential equity implications, relevance to decision-makers, methods for inclusion, and the interpretation and use of such results in decision-making. However, this context underscores the importance of considering not only caregiving but also family health effects, and illustrates the need for consistency between the arguments presented to decision-makers and the analytical approach taken in economic evaluation.

Categories :
Tags :
  • boundary setting
  • decision analytic modeling
  • economic evaluation
  • family effects
  • mental health
  • postnatal depression
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