Estimating the “wider societal impacts” of health conditions and treatments

Background

Health interventions provide benefits to patients which are commonly measured in Quality-Adjusted Life Years (QALYs – the universal unit or currency of health). However they may also have other economic impacts, on other individuals and the rest of society – for instance in enabling a patient to return to work, and therefore contribute more to tax revenues (and require less benefits), or in changing a patient’s utilisation of resources such as residential social care, or informal care provided by their family.

These impacts of treatments beyond health have previously been termed “Wider Societal Impacts” (WSIs). This paper proposes a definition of WSIs as the patient’s net production – their contribution or production of resources, net of their consumption or utilisation of resources– and sets out a systematic approach to measuring net production based on routinely available data.

Finally it provides initial results of the estimation of the amount of net production generated by treatments in different disease areas, and in the marginal activity of the NHS.

Definition of “Wider Societal Impacts” as the patient’s net contribution to society

The approach described is founded on the principle that any resources a patient contributes or produces, net of resources they utilise or consume, are available for others in society to use and benefit from. Similarly, if a patient utilises or consumes resources in excess of the resources they contribute or produce, then those resources must inevitably be provided by society, and are not available for others to consume and benefit from. If a treatment changes the production or consumption of resources by a patient, then it will change the amount of resources available for others to benefit from.

For example, suppose a patient with a particular condition produced £1500 worth of resources per month – through their labour, paid or unpaid. If they consumed £1000 of resources per month, for instance in the normal goods and services used in everyday life, but possibly also by needing social care, or informal care by family – then, in this perspective, they would be judged to provide net production worth £500 per month.

Suppose that a treatment improves the patient’s health, such that they now contribute £1600 worth of resource per month. This increased amount might reflect the fact that they are able to work more. They may also utilise fewer resources, perhaps because they require less care by their family. Suppose they now consume resources worth £900 per month, giving net production of £700 per month. This would imply that the effect of the treatment was to increase the patient’s net production by £200 per month. If the duration of the treatment’s effect was 5 months, the total impact on net production – and the value of the benefits realised by society beyond the patient themselves – would be £1000.