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Published on: January 9, 2016
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Adherence to Discounting Guidelines: Evidence from Over 2000 Published Cost-Effectiveness Analyses
Michelle Q T Kwok1, Mistura A Kareem1, Michael J Cash1
1School of Medicine, Trinity College Dublin, Room 2.12, 2-4 Foster Place, Dublin, Ireland.
Pharmacoeconomics
|April 29, 2020
Summary
Most cost-effectiveness analyses (CEAs) follow discounting guidelines, but adherence varies by country. Inconsistent application of intertemporal discounting in CEAs raises concerns for healthcare resource equity.
Area of Science:
- Health Economics
- Pharmacoeconomics
- Evidence-Based Medicine
Background:
- Cost-effectiveness analyses (CEAs) are crucial for healthcare resource allocation.
- Intertemporal discounting is a key component of CEAs, but adherence to guidelines varies.
- Previous studies indicate a lack of consistent adherence to discounting recommendations.
Purpose of the Study:
- To assess adherence to intertemporal discounting guidelines in a large sample of CEAs.
- To identify factors influencing adherence to discounting recommendations.
- To examine country-specific variations in adherence.
Main Methods:
- A systematic review of 2270 CEAs from seven countries (Australia, Belgium, Canada, Ireland, The Netherlands, New Zealand, UK).
- Data on guideline discount rates and applied rates were extracted from the Tufts CEA Registry.
- Logistic regression was used to analyze the relationship between adherence and explanatory factors.
Main Results:
- Overall adherence to discounting recommendations was 79%.
- Country-specific adherence varied significantly, from 28% in New Zealand to 87% in Belgium and the UK.
- Adherence was higher in recent studies, countries using differential discounting, and manufacturer-sponsored studies.
Conclusions:
- Significant variation exists in adherence to discounting guidelines across countries and over time.
- Incomplete adherence impacts the comparability of CEA evidence.
- Ensuring adherence is critical for equitable access to healthcare resources and should be part of peer review.
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