The Fiscal Consequences Attributed to Changes in Morbidity and Mortality Linked to Investments in Health Care: A Government Perspective Analytic Framework

Connolly, Mark P.; Kotsopoulos, Nikolaos; Postma, Maarten J.; Bhatt, Aomesh

doi:10.1016/j.jval.2016.11.018

Cited by 47 publications

(51 citation statements)

References 10 publications

(11 reference statements)

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“…FHM measures the economic value of a new intervention seen from this perspective. It can be applied following a cohort approach or following a cross-sectional annual population approach using the SAM method [80,81].…”

Section: Finance-focused Toolsmentioning

confidence: 99%

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

Standaert

Sauboin

DeAntonio³

et al. 2020

Journal of Market Access & Health Policy

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Background:Cost-effectiveness analysis (CEA) is the economic analysis method most commonly applied today in the context of replacing one treatment with a new one in a developed healthcare system to improve efficiency. CEA is often requested by local healthcare decisionmakers to grant reimbursement.New preventative interventions, such as new vaccines, may however have much wider benefits inside and outside healthcare, when compared with treatment. These additional benefits include externalities on indirect clinical impact, reallocation of specific healthcare resources, improved quality of care, better productivity, better disease control, better fiscal revenues, and others. But these effects are sometimes difficult to integrate into a meaningful CEA result. They may appear as specific benefits for specific stakeholders, other than the stakeholders in healthcare.Objective: Based on a historical view about the application of economic assessments for vaccines our objective has been to make the inventory of who was/is interested in knowing the economic value of vaccines, in what those different stakeholders are likely to see the benefit from their perspective and how were/are we able to measure those benefits and to report them well. Results: The historical view disclosed a limited interest in the economic assessment of vaccines at start, more than 50 years ago, that was comparable to the assessment of looking for more efficiency in new industries through optimization exercises. Today, we are exposed to a very rich panoply of different stakeholders (n= 16). They have their specific interest in many different facets of the vaccine benefit of which some are well known in the conventional economic analysis (n=9), but most outcomes are hidden and not enough evaluated and reported (n=26). Meanwhile we discovered that many different methods of evaluation have been explored to facilitate the measurement and reporting of the benefits (n=18). Conclusion: Our recommendation for future economic evaluations of new vaccines is therefore to find the right combination among the three entities of stakeholder type selection, outcome measure of interest for each stakeholder, and the right method to apply. We present at the end examples that illustrate how successful this approach can be.

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Section: Finance-focused Toolsmentioning

confidence: 99%

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

Standaert

Sauboin

DeAntonio³

et al. 2020

Journal of Market Access & Health Policy

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show abstract

“…To evaluate the overall influence of technology on the economy, broadening the perspective of evaluations than only look at healthcare-related impacts is needed [11][12][13]. Secondly, investigation is needed for economic consequences outside healthcare, caused either by the disease or by health improvements.…”

Section: Introductionmentioning

confidence: 99%

Estimating the money flow in the economy attributed to rotavirus disease and vaccination in the Netherlands using a Social Accounting Matrix (SAM) framework

Kotsopoulos

Haitsma²,

Connolly

et al. 2019

Expert Review of Pharmacoeconomics & Outcomes Research

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Background: The economics of rotavirus gastroenteritis in infants <5 years old is well-known within healthcare. The financial consequences for families, employers and authorities are not so well explored. The present study evaluates how vaccine prevention changes money flows among those involved in the management of disease, and its consequences. Methods: A Social Accounting Matrix (SAM) framework has been developed reflecting the distribution of income and spending at equilibrium affected by rotavirus disease among all those concerned for 1 year. The data came from official sources and published literature. A comparison of the financial equilibrium between with and without a national rotavirus immunization program has been conducted, along with sensitivity analysis for the results. Results: The total financial cost difference at equilibrium between presence and absence of rotavirus vaccination was +€26.758 million over one year as a net economic surplus. The payment of vaccination (€19.194 million) by the government was offset by the increase in tax revenue (€14.561 million) and by the lower spending in treatment care (€7.998 million). Conclusion: Studying the financial flows between different transacting agents can demonstrate the financial burden of a disease and the benefits of its prevention on agents' income and spending.

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“…There is a broader perspective that can be applied to investments in healthcare interventions using human capital economics that is seldom considered. This perspective can reflect the impact of health on the government finances based on lifetime taxes paid and demand for public benefits linked to disability status attributed to health status [1][2][3]. The government perspective is particularly relevant in tax finance health systems where public money is used to pay for healthcare which is the dominant funder in OECD countries [4].…”

Section: Introductionmentioning

confidence: 99%

“…In contrast with the healthcare perspective, the government public economic perspective can have consequences even in death as health events and disability represent unfulfilled lifetime taxes paid, increased social dependency costs and pension receipts. This perspective implicates that budget impact analysis could be broadened to include the impact of health and technologies across all government budgets, not just health, and how changes in health status will influence other government budgets [1].…”

Section: Introductionmentioning

confidence: 99%

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Estimating the fiscal impact of rare diseases using a public economic framework: a case study applied to hereditary transthyretin-mediated (hATTR) amyloidosis

Connolly

Panda²,

Patris³

et al. 2019

Orphanet J Rare Dis

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Background: A wide range of rare diseases can have fiscal impacts on government finances that extend beyond expected healthcare costs. Conditions preventing people from achieving national lifetime work averages will influence lifetime taxes paid and increase the likelihood of dependence on public income support. Consequently, interventions that influence projected lifetime work activity, morbidity and mortality can have positive and negative fiscal consequences for government. The aim of this study was to apply a public economic framework to a rare disease that takes into consideration a broad range of costs that are relevant to government in relation to transfers received and taxes paid. As a case study we constructed a simulation model to calculate the fiscal life course of an individual with hereditary transthyretin-mediated (hATTR) amyloidosis in The Netherlands. In this lethal disease different progressive disease scenarios occur, including polyneuropathy and/or cardiomyopathy. Results: Due to progressive disability, health care resource use, and early death, hATTR amyloidosis with polyneuropathy receives more transfers from government compared to the general population. In a scenario where a patient is diagnoses with hATTR at age 45, an individual pays €180,812 less in lifetime taxes and receives incrementally €111,695 in transfers from the government, compared to a person without hATTR. Patients suffering from cardiomyopathy die after median 4 years. The health costs of this scenario are therefore lower than that of the other polyneuropathy-based scenarios. Conclusions: The fiscal analysis illustrates how health conditions influence not only health costs, but also the cross-sectorial public economic burden attributed to lost tax revenues and public disability allowances. Due to the progressive nature of hATTR amyloidosis used in this study, public costs including disability increase as the disease progresses with reduced lifetime taxes paid. The results indicate that halting disease progression early in the disease course would generate fiscal benefits beyond health benefits for patients. This analysis highlights the fiscal consequences of diseases and the need for broader perspectives applied to evaluate health conditions. Conventional cost-effectiveness framework used by many health technology assessment agencies have well-documented limitations in the field of rare diseases and fiscal modeling should be a complementary approach to consider.

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The Fiscal Consequences Attributed to Changes in Morbidity and Mortality Linked to Investments in Health Care: A Government Perspective Analytic Framework

Cited by 47 publications

References 10 publications

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

How to assess for the full economic value of vaccines? From past to present, drawing lessons for the future

Estimating the money flow in the economy attributed to rotavirus disease and vaccination in the Netherlands using a Social Accounting Matrix (SAM) framework

Estimating the fiscal impact of rare diseases using a public economic framework: a case study applied to hereditary transthyretin-mediated (hATTR) amyloidosis

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