IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v36y2016i1p31-47.html
   My bibliography  Save this article

Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries

Author

Listed:
  • Christian E. H. Boehler
  • Joanne Lord

Abstract

Background. Published cost-effectiveness estimates can vary considerably, both within and between countries. Despite extensive discussion, little is known empirically about factors relating to these variations. Objectives. To use multilevel statistical modeling to integrate cost-effectiveness estimates from published economic evaluations to investigate potential causes of variation. Methods. Cost-effectiveness studies of statins for cardiovascular disease prevention were identified by systematic review. Estimates of incremental costs and effects were extracted from reported base case, sensitivity, and subgroup analyses, with estimates grouped in studies and in countries. Three bivariate models were developed: a cross-classified model to accommodate data from multinational studies, a hierarchical model with multinational data allocated to a single category at country level, and a hierarchical model excluding multinational data. Covariates at different levels were drawn from a long list of factors suggested in the literature. Results. We found 67 studies reporting 2094 cost-effectiveness estimates relating to 23 countries (6 studies reporting for more than 1 country). Data and study-level covariates included patient characteristics, intervention and comparator cost, and some study methods (e.g., discount rates and time horizon). After adjusting for these factors, the proportion of variation attributable to countries was negligible in the cross-classified model but moderate in the hierarchical models (14%−19% of total variance). Country-level variables that improved the fit of the hierarchical models included measures of income and health care finance, health care resources, and population risks. Conclusions. Our analysis suggested that variability in published cost-effectiveness estimates is related more to differences in study methods than to differences in national context. Multinational studies were associated with much lower country-level variation than single-country studies. These findings are for a single clinical question and may be atypical.

Suggested Citation

  • Christian E. H. Boehler & Joanne Lord, 2016. "Mind the Gap! A Multilevel Analysis of Factors Related to Variation in Published Cost-Effectiveness Estimates within and between Countries," Medical Decision Making, , vol. 36(1), pages 31-47, January.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:1:p:31-47
    DOI: 10.1177/0272989X15579173
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X15579173
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X15579173?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. Andrea Manca & Nigel Rice & Mark J. Sculpher & Andrew H. Briggs, 2005. "Assessing generalisability by location in trial‐based cost‐effectiveness analysis: the use of multilevel models," Health Economics, John Wiley & Sons, Ltd., vol. 14(5), pages 471-485, May.
    2. Richard Grieve & Richard Nixon & Simon G. Thompson & John Cairns, 2007. "Multilevel models for estimating incremental net benefits in multinational studies," Health Economics, John Wiley & Sons, Ltd., vol. 16(8), pages 815-826, August.
    3. Birch, Stephen & Gafni, Amiram, 2003. "Economics and the evaluation of health care programmes: generalisability of methods and implications for generalisability of results," Health Policy, Elsevier, vol. 64(2), pages 207-219, May.
    4. World Bank, 2012. "World Development Indicators 2012," World Bank Publications - Books, The World Bank Group, number 6014.
    5. Richard M. Nixon & Simon G. Thompson, 2005. "Methods for incorporating covariate adjustment, subgroup analysis and between‐centre differences into cost‐effectiveness evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1217-1229, December.
    6. Stephanie Boulenger & John Nixon & Michael Drummond & Philippe Ulmann & Stephen Rice & Gerard Pouvourville, 2005. "Can economic evaluations be made more transferable?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 6(4), pages 334-346, December.
    7. Spath, Hans-Martin & Carrere, Marie-Odile & Fervers, Beatrice & Philip, Thierry, 1999. "Analysis of the eligibility of published economic evaluations for transfer to a given health care system: Methodological approach and application to the French health care system," Health Policy, Elsevier, vol. 49(3), pages 161-177, November.
    8. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196, February.
    9. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
    10. Andrew R. Willan & Eleanor M. Pinto & Bernie J. O'Brien & Padma Kaul & Ron Goeree & Larry Lynd & Paul W. Armstrong, 2005. "Country specific cost comparisons from multinational clinical trials using empirical Bayesian shrinkage estimation: the Canadian ASSENT‐3 economic analysis," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 327-338, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. T I Armina Padmasawitri & Gerardus W Frederix & Bachti Alisjahbana & Olaf Klungel & Anke M Hövels, 2018. "Disparities in model-based cost-effectiveness analyses of tuberculosis diagnosis: A systematic review," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-20, May.
    2. Rachel Song & Varinder Jeet & Rajan Sharma & Martin Hoyle & Bonny Parkinson, 2022. "Cost-Effectiveness Analysis of Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography/Computed Tomography (PET/CT) for the Primary Staging of Prostate Cancer in Australia," PharmacoEconomics, Springer, vol. 40(8), pages 807-821, August.

    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. Thompson, Simon G. & Nixon, Richard M. & Grieve, Richard, 2006. "Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study," Journal of Health Economics, Elsevier, vol. 25(6), pages 1015-1028, November.
    2. Andrew R. Willan & Matthew E. Kowgier, 2008. "Cost‐effectiveness analysis of a multinational RCT with a binary measure of effectiveness and an interacting covariate," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 777-791, July.
    3. Aline Gauthier & Andrea Manca & Susan Anton, 2009. "Bayesian Modelling of Healthcare Resource Use in Multinational Randomized Clinical Trials," PharmacoEconomics, Springer, vol. 27(12), pages 1017-1029, December.
    4. Richard Grieve & John Cairns & Simon G. Thompson, 2010. "Improving costing methods in multicentre economic evaluation: the use of multiple imputation for unit costs," Health Economics, John Wiley & Sons, Ltd., vol. 19(8), pages 939-954, August.
    5. Manuel Gomes & Richard Grieve & Richard Nixon & W. J. Edmunds, 2012. "Statistical Methods for Cost-Effectiveness Analyses That Use Data from Cluster Randomized Trials," Medical Decision Making, , vol. 32(1), pages 209-220, January.
    6. Moreno, Elías & Girón, F.J. & Vázquez-Polo, F.J. & Negrín, M.A., 2012. "Optimal healthcare decisions: The importance of the covariates in cost–effectiveness analysis," European Journal of Operational Research, Elsevier, vol. 218(2), pages 512-522.
    7. Mark J. Sculpher & Karl Claxton & Mike Drummond & Chris McCabe, 2006. "Whither trial‐based economic evaluation for health care decision making?," Health Economics, John Wiley & Sons, Ltd., vol. 15(7), pages 677-687, July.
    8. Mohamed El Alili & Johanna M. van Dongen & Jonas L. Esser & Martijn W. Heymans & Maurits W. van Tulder & Judith E. Bosmans, 2022. "A scoping review of statistical methods for trial‐based economic evaluations: The current state of play," Health Economics, John Wiley & Sons, Ltd., vol. 31(12), pages 2680-2699, December.
    9. Andrea Gabrio & Catrin Plumpton & Sube Banerjee & Baptiste Leurent, 2022. "Linear mixed models to handle missing at random data in trial‐based economic evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 31(6), pages 1276-1287, June.
    10. Jonas Schreyögg & Tom Stargardt & Oliver Tiemann, 2011. "Costs and quality of hospitals in different health care systems: a multi‐level approach with propensity score matching," Health Economics, John Wiley & Sons, Ltd., vol. 20(1), pages 85-100, January.
    11. Pepijn Vemer & Maureen Rutten-van Mölken, 2013. "The Road Not Taken: Transferability Issues in Multinational Trials," PharmacoEconomics, Springer, vol. 31(10), pages 863-876, October.
    12. Oliveira, Monica D. & Bevan, Gwyn, 2008. "Modelling hospital costs to produce evidence for policies that promote equity and efficiency," European Journal of Operational Research, Elsevier, vol. 185(3), pages 933-947, March.
    13. Carmen Selva-Sevilla & F Dámaso Fernández-Ginés & Manuel Cortiñas-Sáenz & Manuel Gerónimo-Pardo, 2021. "Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-18, September.
    14. Manuel Gomes & Karla Díaz-Ordaz & Richard Grieve & Michael G. Kenward, 2013. "Multiple Imputation Methods for Handling Missing Data in Cost-effectiveness Analyses That Use Data from Hierarchical Studies," Medical Decision Making, , vol. 33(8), pages 1051-1063, November.
    15. Md Abu Manju & Math J. J. M. Candel & Gerard J. P. van Breukelen, 2019. "SamP2CeT: an interactive computer program for sample size and power calculation for two-level cost-effectiveness trials," Computational Statistics, Springer, vol. 34(1), pages 47-70, March.
    16. Fernando Antonanzas & Roberto Rodríguez‐Ibeas & Carmelo Juárez & Florencia Hutter & Reyes Lorente & Mariola Pinillos, 2009. "Transferability indices for health economic evaluations: methods and applications," Health Economics, John Wiley & Sons, Ltd., vol. 18(6), pages 629-643, June.
    17. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196, February.
    18. Hege Urdahl & Andrea Manca & Mark Sculpher, 2006. "Assessing Generalisability in Model-Based Economic Evaluation Studies," PharmacoEconomics, Springer, vol. 24(12), pages 1181-1197, December.
    19. Manca, A & Austin, P. C, 2008. "Using propensity score methods to analyse individual patient-level cost-effectiveness data from observational studies," Health, Econometrics and Data Group (HEDG) Working Papers 08/20, HEDG, c/o Department of Economics, University of York.
    20. Richard M. Nixon & Simon G. Thompson, 2005. "Methods for incorporating covariate adjustment, subgroup analysis and between‐centre differences into cost‐effectiveness evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1217-1229, December.

    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:36:y:2016:i:1:p:31-47. 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.