Consensus-based cross-European recommendations for the identification, measurement and valuation of costs in health economic evaluations: a European Delphi study

Lisanne I van Lier, Judith E Bosmans, Hein P J van Hout, Lidwine B Mokkink, Wilbert B van den Hout, G Ardine de Wit, Carmen D Dirksen, Henk L G R Nies, Cees M P M Hertogh, Henriëtte G van der Roest

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OBJECTIVES: Differences between country-specific guidelines for economic evaluations complicate the execution of international economic evaluations. The aim of this study was to develop cross-European recommendations for the identification, measurement and valuation of resource use and lost productivity in economic evaluations using a Delphi procedure.

METHODS: A comprehensive literature search was conducted to identify European guidelines on the execution of economic evaluations or costing studies as part of economic evaluations. Guideline recommendations were extracted by two independent reviewers and formed the basis for the first round of the Delphi study, which was conducted among European health economic experts. During three written rounds, consensus (agreement of 67% or higher) was sought on items concerning the identification, measurement and valuation of costs.

RESULTS: Recommendations from 18 guidelines were extracted. Consensus among 26 panellists from 17 European countries was reached on 61 of 68 items. The recommendations from the Delphi study are to adopt a societal perspective, to use patient report for measuring resource use and lost productivity, to value both constructs with use of country-specific standardized/unit costs and to use country-specific discounting rates.

CONCLUSION: This study provides consensus-based cross-European recommendations on how to measure and value resource use and lost productivity in economic evaluations. These recommendations are expected to support researchers, healthcare professionals, and policymakers in executing and appraising economic evaluations performed in international contexts.

Original languageEnglish
Pages (from-to)993-1008
Number of pages16
JournalThe European Journal of Health Economics
Issue number7
Early online date19 Dec 2017
Publication statusPublished - 1 Sept 2018


  • Costing recommendations
  • Cross-country studies
  • Delphi technique
  • Economic evaluation
  • Journal Article

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