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Setting the boundaries for economic evaluation: Investigating time horizon and family effects in the case of postnatal depression

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JournalValue in Health
DateAccepted/In press - 20 Oct 2017
DateE-pub ahead of print (current) - 22 Nov 2017
Number of pages8
Pages (from-to)1-8
Early online date22/11/17
Original languageEnglish


This study investigates the impact of varying the boundaries of economic evaluation: time horizon and inclusion of family effects. The context is postnatal mental health, where although advocates for investment often include longer-term and family problems in describing the burden of postnatal depression, economic evaluations are usually limited to mothers’ effects with a relatively short time horizon. This discrepancy may lead to suboptimal allocation of healthcare resources.
The question of whether such boundary extensions could make a difference to decision-making is explored using decision analytic models, populated with data from the literature, to estimate the cost-effectiveness of a hypothetical preventive intervention under alternate boundary-setting approaches.
The results suggest that broader boundaries, particularly extension of the time horizon, could make substantial differences to estimated cost-effectiveness. Inclusion of family effects without extension of the time horizon had little impact, but where a longer time horizon was used, family effects could make a significant difference to the conclusions drawn from cost-effectiveness analysis.
Considerations in applying broader boundaries include the substantial resource requirements for evaluation, potential equity implications, relevance to decision-makers, methods for inclusion, and the interpretation and use of such results in decision-making. However, this context underscores the importance of considering not only caregiving but also family health effects, and illustrates the need for consistency between the arguments presented to decision-makers and the analytical approach taken in economic evaluation.

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© 2017, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy.

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