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Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case

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Utilizing large observational datasets like CPRD for economic evaluations of public health interventions is feasible. This asthma intervention study showed potential cost savings and minimal quality-adjusted life-year loss.

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Area of Science:

  • Health economics
  • Public health research
  • Clinical trial methodology

Background:

  • Large observational datasets, such as the Clinical Practice Research Datalink (CPRD), offer efficient designs for clinical studies and economic evaluations.
  • Utilizing existing healthcare data can streamline research processes and reduce costs associated with primary data collection.

Purpose of the Study:

  • To detail the economic evaluation methodology for a UK National Health Service (NHS)-delivered public health intervention for childhood asthma.
  • To assess the impact of this methodology, using CPRD data, on the study's results.
  • To evaluate the feasibility and efficiency of using large observational databases for economic evaluations.

Main Methods:

  • A cluster randomised controlled trial (RCT) utilized CPRD data, identifying eligible asthma patients via diagnostic codes.
  • Healthcare contacts were captured for one year pre- and post-intervention (August 2012–July 2014).
  • Quality-adjusted life-years (QALYs) were estimated using utility values from a systematic review, and costs were bootstrapped with and without baseline adjustment (BA).

Main Results:

  • The primary analysis included 8190 patients; the intervention resulted in a per-patient incremental QALY loss of 0.00017.
  • Observed cost savings were £14.74, while baseline-adjusted savings were £36.07.
  • The probability of cost savings was significantly higher with baseline adjustment (96.3%) compared to observed costs (67.3%) due to baseline cost differences.

Conclusions:

  • Economic evaluations are feasible, informative, and potentially efficient when using data from large observational databases without primary data collection.
  • This methodology provides valuable insights into the economic impact of public health interventions.
  • The study highlights the utility of CPRD in evaluating healthcare interventions and informing health economic decisions.