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Comment & Response
August 13, 2019

Time Horizons in Cost Analyses

Author Affiliations
  • 1Global Health Economics, Amgen (Europe) GmbH, Rotkreuz, Switzerland
  • 2Division of Hematology, Mayo Clinic, Rochester, Minnesota
  • 3Centre for Health Economics, University of York, York, England
JAMA. 2019;322(6):582-583. doi:10.1001/jama.2019.7853

To the Editor Drs Basu and Maciejewski1 discussed time horizons in economic models, which should be long enough to capture all potential differences in outcomes associated with the treatments compared. For therapies extending survival over the entire life span, a lifetime horizon is recommended. However, survival trajectories among patient subgroups may vary and can influence survival in a nonlinear fashion. In these situations, using average survival gains to estimate a time horizon can be misleading and may result in the use of a time horizon that is shorter than the expected survival in certain subgroups.2 We illustrate the importance of 2 types of heterogeneity: heterogeneity observed at baseline (eg, age) and not observed at baseline (eg, response to treatment). The implications of the time horizon from a payer perspective are also discussed.