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Accounting for future costs in medical cost-effectiveness analysis
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Abstract
Most medical cost-effectiveness analyses include future costs only for related illnesses,
but this approach is controversial. This paper demonstrates that cost-effectiveness
analysis is consistent with lifetime utility maximization only if it includes all
future medical and non-medical expenditures. Estimates of the magnitude of these future
costs suggest that they may substantially alter both the absolute and relative cost-effectiveness
of medical interventions, particularly when an intervention increases length of life
more than quality of life. In older populations, current methods overstate the cost-effectiveness
of interventions which extend life compared to interventions which improve the quality
of life.