IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v30y2010i5p536-543.html
   My bibliography  Save this article

Cost-Effectiveness Analysis: Discount the Placebo at Your Peril

Author

Listed:
  • Neil Hawkins

    (Oxford Outcomes Ltd., Oxford, UK, Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington, York, UK, neil.hawkins@oxfordoutcomes.com)

  • David A. Scott

    (Oxford Outcomes Ltd., Oxford, UK, Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK)

Abstract

Introduction: The authors consider alternative mechanisms that might explain placebo responses and their implications for cost-effectiveness modeling. Three alternative placebo mechanisms are examined: a ‘‘regression to the mean’’ effect arising from natural variation and the preferential selection of patients with acutely severe disease into clinical trials, a patient expectancy effect specific to the clinical trial setting (Hawthorne effect), and a patient expectancy effect generalizable to routine clinical practice (true placebo effect). Methods: To estimate cost-effectiveness, the authors needed to generalize from trial data to estimate responses to treatment that they would see in routine clinical practice. They use an example analysis of the cost-effectiveness of adjunct epilepsy treatments to illustrate the potential effects of these different placebo mechanisms on this generalization and subsequent cost-effectiveness estimates and adoption decisions. Results: If an acceptable willingness-to-pay threshold of 30,000 per quality-adjusted life year (QALY) is assumed, then each of the placebo effect scenarios identifies a different treatment alternative as being optimum. Discussion: Estimated cost-effectiveness ratios and associated policy decisions may be sensitive to assumptions regarding the mechanism underlying placebo responses. These assumptions should, if possible, be investigated through analysis of trial or observational data and, in the absence of other evidence, sensitivity analysis.

Suggested Citation

  • Neil Hawkins & David A. Scott, 2010. "Cost-Effectiveness Analysis: Discount the Placebo at Your Peril," Medical Decision Making, , vol. 30(5), pages 536-543, September.
    • Handle: RePEc:sae:medema:v:30:y:2010:i:5:p:536-543
    DOI: 10.1177/0272989X10362106
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X10362106
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X10362106?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Neil Hawkins & David Epstein & Michael Drummond & Jennifer Wilby & Anita Kainth & David Chadwick & Mark Sculpher, 2005. "Assessing the Cost-Effectiveness of New Pharmaceuticals in Epilepsy in Adults: The Results of a Probabilistic Decision Model," Medical Decision Making, , vol. 25(5), pages 493-510, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Susan Griffin & Helen Weatherly & Gerry Richardson & Mike Drummond, 2008. "Methodological issues in undertaking independent cost-effectiveness analysis for NICE: the case of therapies for ADHD," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(2), pages 137-145, May.
    2. John Hornberger & Katherine Robertus, 2005. "Comprehensive Evaluations of Health Care Interventions: The Realism-Transparency Tradeoff," Medical Decision Making, , vol. 25(5), pages 490-492, September.
    3. Steven M. Teutsch & Marc L. Berger, 2005. "Evidence Synthesis and Evidence-Based Decision Making: Related But Distinct Processes," Medical Decision Making, , vol. 25(5), pages 487-489, September.
    4. Louise B. Russell, 2005. "Comparing Model Structures in Cost-Effectiveness Analysis," Medical Decision Making, , vol. 25(5), pages 485-486, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:30:y:2010:i:5:p:536-543. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.