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Cost-effectiveness league tables: valuable guidance for decision makers?
Josephine Mauskopf1, Frans Rutten, Warren Schonfeld
1Health Economics and Outcomes Strategy, RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA. jmauskopf@rti.org
Cost-effectiveness league tables can be improved for healthcare decision-making. This study proposes a reference case approach and expanded measures for more consistent and effective use of incremental cost-effectiveness ratios (ICERs).
Area of Science:
- Health Economics
- Health Technology Assessment
- Decision Science
Background:
- Cost-effectiveness league tables rank healthcare interventions using incremental cost-effectiveness ratios (ICERs).
- These tables are valuable for resource allocation but often use inconsistent methodologies.
- Methodological variations can impact intervention rankings and decision-making.
Purpose of the Study:
- To evaluate the utility of cost-effectiveness league tables for decision-makers.
- To address limitations in current league table methodologies and data presentation.
- To propose improvements for more reliable and consistent healthcare intervention evaluation.
Main Methods:
- Critically reviewed existing methodologies for computing incremental cost-effectiveness ratios (ICERs).
- Proposed a standardized 'reference case' approach for ICER calculation.
- Recommended an expanded set of measures for inclusion in league tables.
Main Results:
- Identified significant methodological heterogeneity in current ICER calculations (e.g., comparators, discount rates, time horizons).
- Highlighted the general absence of uncertainty measures in existing league tables.
- Proposed a framework for a central repository of standardized league tables.
Conclusions:
- Current cost-effectiveness league tables present challenges for consistent decision-making due to methodological variations.
- A reference case approach and expanded measures can enhance the reliability and comparability of ICERs.
- Standardized league tables in a central repository would improve their utility for healthcare resource allocation.
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