Which statement describes how adverse events are handled in economic evaluations?

• A. They are ignored if rare.
• B. They are assigned costs and disutilities and included in total costs and outcomes.
• C. They are used to adjust only the discount rate.
• D. They determine the time horizon.

Answer: (B)

In economic evaluations, adverse events are incorporated by assigning them both costs and disutilities and including them in the total costs and outcomes. This means estimating how likely each adverse event is, calculating the financial costs it adds (hospitalizations, additional treatments, monitoring, etc.), and adding that to the overall cost. At the same time, each event carries a loss in health-related quality of life, captured as a disutility or a temporary drop in utility, which reduces the expected QALYs proportional to its probability and the time the patient experiences it. This approach ensures harms are reflected alongside benefits, giving a complete picture of a treatment’s value.

Adverse events should not be ignored even if rare, because their costs and utility losses can influence the overall comparison. They are not used merely to adjust the discount rate, and they do not determine the time horizon—the horizon is about capturing all relevant costs and outcomes over time. By integrating adverse events into both costs and outcomes, the analysis accurately represents the real-world impact of a treatment.