Medical interventions that increase life expectancy of patients result in additional consumption of non-medical goods and services in ‘added life years’. This paper focuses on the distributional consequences across socio-economic groups of including these costs in cost effectiveness analysis. In that context, it also highlights the role of remaining quality of life and household economies of scale. Data from a Dutch household spending survey was used to estimate non-medical consumption and household size by age and educational attainment. Estimates of non-medical consumption and household size were combined with life tables to estimate what the impact of including non-medical survivor costs would be on the incremental cost effectiveness ratio (ICER) of preventing a death at a certain age. Results show that including non-medical survivor costs increases estimated ICERs most strongly when interventions are targeted at the higher educated. Adjusting for household size (lower educated people less often live additional life years in multi-person households) and quality of life (lower educated people on average spend added life years in poorer health) mitigates this difference. Ignoring costs of non-medical consumption in economic evaluations implicitly favors interventions targeted at the higher educated and thus potentially amplifies socio-economic inequalities in health.

中文翻译：

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在经济评估中包括幸存者成本的分配后果

增加患者预期寿命的医疗干预导致在“延长寿命年”中额外消费非医疗商品和服务。本文重点关注将这些成本纳入成本效益分析的社会经济群体的分配后果。在这种情况下，它还强调了保持生活质量和家庭规模经济的作用。来自荷兰家庭支出调查的数据用于按年龄和教育程度估算非医疗消费和家庭规模。将非医疗消费和家庭规模的估计值与生命表相结合，以估计包括非医疗幸存者成本对预防特定年龄死亡的增量成本效益比 (ICER) 的影响。结果表明，当干预措施针对受过高等教育的人时，包括非医疗幸存者成本在内的估计 ICER 最显着增加。调整家庭规模（受教育程度较低的人在多人家庭中寿命延长的情况较少）和生活质量（受教育程度较低的人平均寿命延长，健康状况较差）可以减轻这种差异。在经济评估中忽略非医疗消费的成本隐含地有利于针对受过高等教育的干预措施，因此可能会放大健康方面的社会经济不平等。调整家庭规模（受教育程度较低的人在多人家庭中寿命延长的情况较少）和生活质量（受教育程度较低的人平均寿命延长，健康状况较差）可以减轻这种差异。在经济评估中忽略非医疗消费的成本隐含地有利于针对受过高等教育的干预措施，因此可能会放大健康方面的社会经济不平等。调整家庭规模（受教育程度较低的人在多人家庭中寿命延长的情况较少）和生活质量（受教育程度较低的人平均寿命延长，健康状况较差）可以减轻这种差异。在经济评估中忽略非医疗消费的成本隐含地有利于针对受过高等教育的干预措施，因此可能会放大健康方面的社会经济不平等。