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How often do sensitivity analyses for economic parameters change cost-utility analysis conclusions?
Bruce R Schackman1, Heather Taffet Gold, Patricia W Stone
1Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Medical College of Cornell University, New York 10021, USA. brs2006@med.cornell.edu
Pharmacoeconomics
|April 6, 2004
Summary
Sensitivity analyses in pharmaceutical cost-utility studies are common and often change conclusions. Health-related quality of life and cost changes frequently impact results, unlike discount rates, highlighting the need for better study quality and parameter justification.
Area of Science:
- Health economics
- Pharmacoeconomics
- Decision analysis
Background:
- Limited evidence exists on the application of sensitivity analysis in cost-effectiveness literature.
- Sensitivity analyses for health-related quality of life (HR-QOL), cost, and discount rates are crucial for assessing uncertainties.
Purpose of the Study:
- To examine the use of sensitivity analyses in pharmaceutical cost-utility literature.
- To determine if changes in economic parameters alter cost-effectiveness conclusions.
Main Methods:
- Reviewed 70 pharmaceutical cost-utility analyses, auditing 122 base cases for sensitivity analyses.
- Examined HR-QOL, cost, and discount rate sensitivity analyses (n=133, 99, 128 respectively).
- Recorded cost-utility thresholds and compared quality ratings of studies where sensitivity analyses crossed thresholds.
Main Results:
- Common thresholds were $US20,000, $US50,000, and $US100,000/QALY.
- Sensitivity analyses crossed thresholds in 31% (HR-QOL), 20% (cost), and 15% (discount rate).
- Studies with crossed thresholds showed moderate quality and better parameter justification.
Conclusions:
- Sensitivity analyses are widely used and frequently alter cost-effectiveness conclusions.
- HR-QOL and cost parameters are key drivers of uncertainty, informing guideline recommendations.
- Improving study quality and parameter justification enhances the value of sensitivity analyses.
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