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Randomized trials with concurrent economic evaluations reported unrepresentatively large clinical effect sizes.

Simon Gilbody1, Peter Bower, Alex J Sutton

  • 1Department of Health Sciences, University of York, York YO10 5DD, UK. sg519@york.ac.uk

Journal of Clinical Epidemiology
|July 4, 2007
PubMed
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Economic evaluations of enhanced depression care may overestimate clinical effectiveness. Studies with economic evaluations showed larger effect sizes than those without, suggesting potential bias in cost-effectiveness research.

Area of Science:

  • Health Economics
  • Clinical Effectiveness Research
  • Mental Health Interventions

Background:

  • Randomized economic evaluations are crucial for healthcare decision-making.
  • Concerns exist regarding the potential for bias in reported clinical effectiveness within these studies.
  • Enhanced care for depression is a widely studied intervention.

Purpose of the Study:

  • To investigate if randomized economic evaluations of enhanced depression care report clinical effectiveness estimates that differ from the broader research literature.
  • To assess the representativeness of clinical data used in economic evaluations.

Main Methods:

  • A meta-regression analysis was conducted on 36 studies (12,294 patients) of enhanced care for depression.
  • Clinical effect sizes were compared between studies with and without concurrent economic evaluations.

Related Experiment Videos

  • Pooled standardized mean differences (SMDs) were calculated.

    • Main Results:

    • Studies including an economic evaluation demonstrated a pooled clinical effect size nearly double that of studies without economic evaluations (SMD=0.34 vs. 0.17).
    • This difference in effect sizes was statistically significant (P=0.02).
    • The findings suggest a potential overestimation of treatment benefits in studies publishing economic evaluations.

    Conclusions:

    • The publication of an economic evaluation for enhanced depression care was associated with larger reported clinical effect sizes.
    • Cost-effectiveness estimates derived from such studies warrant cautious interpretation.
    • The representativeness of clinical data underlying economic evaluations requires careful consideration and further investigation.