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Patient Variability Seldom Assessed in Cost-effectiveness Studies

Author

Listed:
  • Tara A. Lavelle

    (Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • David M. Kent

    (Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • Christine M. Lundquist

    (Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • Teja Thorat

    (Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • Joshua T. Cohen

    (Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • John B. Wong

    (Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Division of Clinical Decision Making, Boston, MA, USA)

  • Natalia Olchanski

    (Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

  • Peter J. Neumann

    (Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA)

Abstract

Background. Cost-effectiveness analysis (CEA) estimates can vary substantially across patient subgroups when patient characteristics influence preferences, outcome risks, treatment effectiveness, life expectancy, or associated costs. However, no systematic review has reported the frequency of subgroup analysis in CEA, what type of heterogeneity they address, and how often heterogeneity influences whether cost-effectiveness ratios exceed or fall below conventional thresholds. Methods. We reviewed the CEA literature cataloged in the Tufts Medical Center CEA Registry, a repository describing cost-utility analyses published through 2016. After randomly selecting 200 of 642 articles published in 2014, we ascertained whether each study reported subgroup results and collected data on the defining characteristics of these subgroups. We identified whether any of the CEA subgroup results crossed conventional cost-effectiveness benchmarks (e.g., $100,000 per QALY) and compared characteristics of studies with and without subgroup-specific findings. Results. Thirty-eight studies (19%) reported patient subgroup results. Articles reporting subgroup analyses were more likely to be US-based, government funded (v. drug industry- or nonprofit foundation-funded) studies, with a focus on primary or secondary (v. tertiary) prevention (P

Suggested Citation

  • Tara A. Lavelle & David M. Kent & Christine M. Lundquist & Teja Thorat & Joshua T. Cohen & John B. Wong & Natalia Olchanski & Peter J. Neumann, 2018. "Patient Variability Seldom Assessed in Cost-effectiveness Studies," Medical Decision Making, , vol. 38(4), pages 487-494, May.
  • Handle: RePEc:sae:medema:v:38:y:2018:i:4:p:487-494
    DOI: 10.1177/0272989X17746989
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    References listed on IDEAS

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    1. Anthony J Culyer & Yvonne Bombard, 2011. "An Equity Checklist: a Framework for Health Technology Assessments," Working Papers 062cherp, Centre for Health Economics, University of York.
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