On time horizons in health economic evaluations
File(s)
Accepted version
Author(s)
Haacker, Markus
Hallett, Timothy
Atun, Rifat
Type
Journal Article
Abstract
The issue of time horizons has received scant attention in discussions pertaining to health economic evaluations unlike discounting or translation of health outcomes into life-cycle measures (e.g. Quality Adjusted Life Years (QALYs) or Disability Adjusted Life Years (DALYs)). The available guidelines do not offer clear and consistent guidance for many problems addressed in health economic evaluations. In practice, variation of time horizons between studies for the same diseases is a matter of concern, as results on cost-effectiveness depend on the time horizon. Our paper contributes to establishing a consistent approach to setting time horizons across common types of health economic evaluations and mitigating potential bias where the choice of a time horizon may affect results of the evaluation. We find that available guidance is clear only for patient-focused interventions, but not in the presence of population-level effects owing to transmission of infections or other linkages. We distinguish between a policy period – over which an intervention is delivered or initiated – and an evaluation period over which the effects are measured. One important challenge in establishing a time horizon for evaluation is that, at least for infectious diseases, the state of the epidemic at the end of the policy period cannot be evaluated precisely and incorporated in the results of an economic evaluation. While longer policy periods partly mitigate this challenge, they are subject to greater uncertainty, and outcomes may not adequately reflect the cost-effectiveness of current policies because outcomes reflect an average over the policy period. Incremental analysis on interventions implemented in sub-periods of the policy period (especially at the beginning) potentially improves accuracy and helps to identify potential for improving cost-effectiveness by varying the path of implementation or the mix of interventions offered over time.
Date Issued
2020-11-01
Date Acceptance
2020-05-31
Citation
Health Policy and Planning, 2020, 35 (9), pp.1237-1243
ISSN
0268-1080
Publisher
Oxford University Press (OUP)
Start Page
1237
End Page
1243
Journal / Book Title
Health Policy and Planning
Volume
35
Issue
9
Copyright Statement
©The Author(s) 2020. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. This is a pre-copy-editing, author-produced version of an article accepted for publication in Health Policy Plan following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/heapol/article/35/9/1237/5934743
Sponsor
Medical Research Council (MRC)
Grant Number
MR/R015600/1
Subjects
Time horizon
benefit–cost analysis
cost-effectiveness analysis
economic evaluation
global health
health economics
methods
policy evaluation
public health
Health Policy & Services
1117 Public Health and Health Services
1605 Policy and Administration
1606 Political Science
Publication Status
Published
Date Publish Online
2020-10-21