Adherence to the iDSI reference case among published cost-per-DALY averted studies

Area of Science:

• Global Health
• Health Economics
• Evidence-Based Policy

Background:

• The International Decision Support Initiative (iDSI) reference case, published in 2014, provides guidelines for cost-effectiveness analyses (CEA).
• This study evaluates the impact of the iDSI reference case on the quality of CEAs using disability-adjusted life-years (DALYs).

Purpose of the Study:

• To assess the association between the iDSI reference case guideline and improvements in methodological and reporting practices for CEAs.
• To quantify adherence to the iDSI reference case principles in published studies.

Main Methods:

• Analysis of the Tufts Medical Center Global Health CEA Registry for studies published between 2011 and 2017.
• Development of binary questions to score adherence to 11 iDSI principles, calculating separate methodological and reporting adherence scores.
• Pre-post analysis using 2014 as the dissemination year, with sensitivity analyses for scoring criteria, dissemination period, and comparator classification.

Main Results:

• Articles achieved an average of 60% adherence to methodology and 74% to reporting standards.
• Methodological adherence showed no significant improvement (59% pre-2014 vs. 60% post-2014).
• Reporting adherence scores slightly improved (72% pre-2014 vs. 75% post-2014, p<0.01), consistently exceeding methodological scores.
• Budget impact and equity were seldom addressed (9-10% and 7% respectively).

Conclusions:

• The iDSI reference case has potential as a valuable resource for global health research and policy.
• Increased efforts in promoting adherence and awareness are necessary to fully realize the guideline's potential.
• While reporting practices showed slight improvement, methodological adherence requires further attention.