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Related Experiment Videos

Multilevel models for estimating incremental net benefits in multinational studies.

Richard Grieve1, Richard Nixon, Simon G Thompson

  • 1Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK. richard.grieve@lshtm.ac.uk

Health Economics
|December 28, 2006
PubMed
Summary

Multilevel models (MLMs) for cost-effectiveness analysis (CEA) require careful assumption evaluation. Models allowing for center-specific differences and variances provide more accurate inferences on incremental net benefits (INBs).

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Area of Science:

  • Health Economics
  • Biostatistics
  • Pharmacoeconomics

Background:

  • Multilevel models (MLMs) are frequently used for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA).
  • Standard MLM assumptions include exchangeability of INBs and common variance across centers.
  • These assumptions may not hold in multinational CEA settings.

Purpose of the Study:

  • To examine the plausibility of standard MLM assumptions in multinational CEA.
  • To compare various MLMs for estimating mean INB under different assumption sets.
  • To assess the impact of assumption violations on inference validity.

Main Methods:

  • Comparison of different multilevel models (MLMs) for estimating mean incremental net benefits (INBs).

Related Experiment Videos

  • Evaluation of models with varying assumptions regarding exchangeability and variance across centers.
  • Assessment of model fit and inference appropriateness based on data.

    • Main Results:

    • MLMs assuming exchangeable INBs and common variance led to incorrect inferences.
    • Models incorporating covariates for systematic center differences and estimating unique variances per center showed better fit.
    • These more flexible MLMs resulted in more appropriate inferences for multinational CEA.

    Conclusions:

    • The assumptions of exchangeability and common variance in MLMs for CEA are often not plausible.
    • MLMs should include covariates to account for center-specific effects and estimate varying variances.
    • Critical evaluation of MLM assumptions is essential for drawing reliable conclusions in cost-effectiveness analysis.