OBJECTIVES: To examine trends in the inclusion of societal costs (SC) in published cost-effectiveness analyses (CEAs), factors associated with their inclusion, and the impact of SC on total incremental costs.

METHODS: We analyzed CEAs published from 2013 to 2022 that reported quality-adjusted life-years (QALYs) from the Tufts Medical Center’s CEA Registry (n=6,838). We examined trends in the percentage of CEAs that included SC. We examined the associations between study characteristics and inclusion of SC in a multivariate logistic regression. We assessed the impact of SC on incremental costs among studies that reported both healthcare and societal perspective.

RESULTS: Between 2013 and 2022, the percentage of CEAs with SC increased from 19% to 26%. Productivity was the most frequently reported SC (10% of all studies), followed by transportation (8%), caregiver (6%), patient time (5%) and consumption (1%). Compared to the US, studies from Scandinavian countries (adjusted odds ratio [OR]: 3.6) and Netherlands (5.3) had significantly higher odds of including SC. Studies from Canada (0.67), Australia (0.59), and the UK (0.36) had lower odds. Compared to CEAs related to cancer, studies on mental health disorders (adjusted OR: 6.8), connective tissue diseases (4.1), respiratory (3.1) and infectious diseases (1.7) had higher odds of including SC. Compared to pharmaceutical studies, studies on immunization (adjusted OR: 4.3), care delivery (2.1), medical procedures (1.5), diagnostic and screening (1.3) had higher odds of including SC. Studies in pediatric population (adjusted OR: 1.7) had higher odds of including SC compared to those in adults, while studies in the elderly (0.68) had lower odds. Upon inclusion of SC, incremental costs increased in 42% and decreased in 51% of studies.

CONCLUSIONS: Despite a recent uptick, inclusion of SC in CEAs remains low. Substantial variation exists by country, disease area, intervention type, and population age.