Including the costs of non-medical consumption in life years gained in economic evaluations of medical interventions has been controversial. This paper focuses on the estimation of these costs using Dutch data coming from cross-sectional household surveys consisting of 56,569 observations covering the years 1978–2004. We decomposed the costs of consumption into age, period and cohort effects and modelled the non-linear age and cohort patterns of consumption using P-splines. As consumption patterns depend on household composition, we also estimated household size using the same regression modeling strategy. Estimates of non-medical consumption and household size were combined with life tables to estimate the impact of including non-medical survivor costs on an incremental cost-effectiveness ratio (ICER). Results revealed that including non-medical survivor costs substantially increases the ICER, but the effect varies strongly with age. The impact of cohort effects is limited but ignoring household economies of scale results in a significant overestimation of non-medical costs. We conclude that a) ignoring the costs of non-medical consumption results in an underestimation of the costs of life prolonging interventions b) economies of scale within households with respect to consumption should be accounted for when estimating future costs.

在医疗干预的经济评估中包括生命年中非医疗消费的成本一直存在争议。本文重点使用来自横断面住户调查的荷兰数据对这些成本的估计，该调查由涵盖 1978-2004 年的 56,569 次观察组成。我们将消费成本分解为年龄、时期和群组效应，并使用 P 样条对消费的非线性年龄和群组模式进行建模。由于消费模式取决于家庭构成，我们还使用相同的回归建模策略估计了家庭规模。非医疗消费和家庭规模的估计与生命表相结合，以估计包括非医疗幸存者成本对增量成本效益比 (ICER) 的影响。结果显示，包括非医疗幸存者费用会大大增加 ICER，但效果随年龄变化很大。队列效应的影响有限，但忽略家庭规模经济会导致对非医疗成本的严重高估。我们得出的结论是：a) 忽略非医疗消费的成本会导致对延长寿命干预措施的成本的低估 b) 在估计未来成本时应考虑家庭内部与消费相关的规模经济。