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Cost-minimisation analysis versus cost-effectiveness analysis, revisited.

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This summary is machine-generated.

Cost-minimisation analysis (CMA) should rarely be used in health economic evaluations. This study shows CMA can bias results, leading to incorrect conclusions about treatment cost-effectiveness, and recommends its discontinuation.

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Area of Science:

  • Health Economics
  • Pharmacoeconomics
  • Clinical Trial Analysis

Background:

  • Cost-minimisation analysis (CMA) has been debated for its appropriateness in health economic evaluations since 2001.
  • Despite previous critiques, the use of CMA persists in various trial contexts.
  • Understanding the limitations of CMA is crucial for accurate economic assessments.

Purpose of the Study:

  • To determine the appropriate use cases for cost-minimisation analysis (CMA) versus cost-effectiveness analysis (CEA).
  • To review the evolution and current application of CMA since its declared obsolescence.
  • To assess the potential biases introduced by CMA in economic evaluations.

Main Methods:

  • Literature review examining the use of CMA post-2001.
  • Analysis of simulated and trial data to illustrate CMA's performance.
  • Evaluation of CMA's impact on uncertainty measures and cost-effectiveness probability.

Main Results:

  • CMA continues to be employed, despite its known limitations.
  • CMA can significantly bias uncertainty measures, affecting the estimation of value of information and cost-effectiveness.
  • Bias is negligible only in specific non-inferiority scenarios with vastly different costs.

Conclusions:

  • Cost-minimisation analysis (CMA) is generally inappropriate for trial-based economic evaluations.
  • Cost-effectiveness analysis (CEA), including joint distribution of costs and benefits, is almost always necessary to avoid biased uncertainty estimation.
  • The application of CMA is narrower than previously understood, suggesting it should be abandoned.