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Surrogates, meta-analysis and cost-effectiveness modelling: a combined analytic approach.
Neil Hawkins1, Gerry Richardson, Alex J Sutton
1Centre for Health Economics, University of York, Heslington,York, UK. nsh2@york.ac.uk
Health Economics
|July 29, 2011
Summary
Combining trial and model-based analyses for cost-effectiveness studies improves accuracy. This joint approach uses both surrogate and final endpoints, offering a more comprehensive evaluation of interventions like the Chronic Disease Self-Management Programme.
Area of Science:
- Health Economics
- Clinical Trial Analysis
- Biostatistics
Background:
- Cost-effectiveness analyses (CEA) are crucial for healthcare decision-making.
- Traditional CEAs rely on direct trial data or indirect model-based analyses using surrogate endpoints.
- Surrogate endpoints may not perfectly predict final clinical outcomes, introducing uncertainty.
Purpose of the Study:
- To introduce and evaluate a joint analysis approach for CEA.
- To compare estimates from direct trial-based, indirect model-based, and joint analyses.
- To assess the impact of different analytical approaches on intervention cost-effectiveness and future research value.
Main Methods:
- Utilized data from clinical trials containing both surrogate and final endpoints.
- Performed a joint analysis integrating trial and model-based approaches.
- Relaxed the conditional independence assumption common in indirect analyses.
- Applied the methods to a cost-effectiveness analysis of the Chronic Disease Self-Management Programme.
Main Results:
- Different analytical approaches yielded varying cost-effectiveness estimates for the intervention.
- Estimates of the value of future research also differed across methods.
- The joint analysis provided a potentially more robust estimate by incorporating all available endpoint data.
Conclusions:
- The choice of analytical approach significantly impacts CEA results.
- Joint analysis offers an advantage by leveraging both surrogate and final endpoints without strong independence assumptions.
- Careful consideration of the analytical strategy is essential for reliable health economic evaluations.
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