Research in Progress: "Whose QALYs Count in Cost-Effectiveness Analyses? How Interventions That Affect Fertility and Childbearing are Evaluated"

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Current guidelines for economic evaluations of health interventions (cost-effectiveness or cost-benefit analyses) define relevant outcomes as those accruing to individuals receiving interventions. Little consensus exists on how to count health impacts of interventions that affect current and future fertility and childbearing. We sought to characterize current practices for counting such health outcomes. To do so, we developed a framework characterizing health interventions with direct and/or indirect effects on fertility and childbearing. We identified interventions that span the framework and performed a targeted literature review for economic evaluations of these interventions. For each article, we characterized how the potential health outcomes from each intervention were considered, focusing on QALYs associated with fertility and childbearing. This review of 108 economic evaluations led to striking insights about choices analysts make in the absence of clear guidance about how to include such QALYs. We will discuss these insights and their implications as well as the rationales on which they are based. In brief, economic evaluations inconsistently consider QALYs from current pregnancies and future fertility in ways that frequently appear biased. Given this, we believe that further guidance should be given by bodies like the Panel on Cost-Effectiveness in Health and Medicine to help to standardize practice and reporting in this important area.