Hurdles that impede economic evaluations of welfare interventions

Abstract

Compared with economic evaluations of healthcare interventions, less experience has been gained in the field of economic evaluation of welfare interventions. This review suggests possible approaches to address four previously identified hurdles in economic evaluations of welfare interventions. After literature was searched through MEDLINE and EMBASE, it was found that Health-Related-Quality-of-Life questionnaires related to the condition of the target population are needed, instead of generic instruments. These condition-specific instruments use a multidimensional approach. There are specific instruments needed to take account of influences on informal caregivers. Moreover, it was shown that several aspects, such as crime rates and employment should be considered to estimate the impact on societal costs. Finally, the intervention must be described in detail and well defined to reduce variability. In conclusion, economic evaluations of welfare interventions increase complexity. These must be accounted for to permit valid assessments of the value for money of welfare interventions.

Keywords:

• economic evaluation
• healthcare intervention
• policy
• quality-adjusted life year
• quality-of-life
• welfare intervention

Financial & competing interests disclosure

The authors were funded by ‘Steunpunt Welzijn, Volksgezondheid en Gezin (SWVG)’, an initiative of the Flemish government. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• There is a growing need for economic evaluations of healthcare and welfare interventions to make informed policy decisions, but there is still little experience gained in the welfare sector.

• Condition-specific outcomes are often neglected in economic evaluations of healthcare and welfare interventions due to the common use of generic questionnaires.

• Quality of life (QoL) externalities are often neglected in the calculation of QoL in economic evaluations of these kinds of interventions.

• Utility scores can only be derived from a small number of existing QoL questionnaires. If utility scores are available, utilities obtained from generic and condition-specific questionnaires are assessed on different scales.

• The impact of costs is often calculated from a too narrow perspective.

• There is need for a detailed description of interventions to minimalize bias.

• There are difficulties to standardize interventions carried out by humans. Standardization is also needed to minimalize bias.

• The appearance of a human factor in these interventions (e.g., caregiver–patient relationship) can possibly affect outcomes.