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Published on: September 10, 2018
Perspective and Costing in Cost-Effectiveness Analysis, 1974-2018
David D Kim1,2, Madison C Silver3, Natalia Kunst4,5,6
1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Box 063, Boston, MA, 02111, USA. dkim3@tuftsmedicalcenter.org.
Cost-effectiveness analyses (CEAs) often lack transparency in perspective and costing. A societal perspective yields more favorable incremental cost-effectiveness ratios (ICERs) than a healthcare sector perspective, highlighting the need for clear reporting.
Area of Science:
- Health economics
- Pharmacoeconomics
- Health services research
Background:
- Cost-effectiveness analyses (CEAs) are crucial for healthcare decision-making.
- Standardization of perspective and costing approaches in CEAs is essential for reliable comparisons.
- Existing CEA registries provide valuable data on study methodologies and outcomes.
Purpose of the Study:
- To examine the perspectives and costing approaches utilized in CEAs.
- To analyze the distribution of reported incremental cost-effectiveness ratios (ICERs).
- To assess the impact of different perspectives on ICERs and identify inconsistencies in reporting.
Main Methods:
- Analysis of the Tufts Medical Center's CEA and Global Health CEA registries (6907 cost-per-quality-adjusted-life-year [QALY] and 698 cost-per-disability-adjusted-life-year [DALY] studies).
- Review of 45 country-specific guidelines on recommended analytic perspectives.
- Examination of non-health consequences and their influence on ICERs.
Main Results:
- Study authors frequently mis-specified or omitted the perspective used; a healthcare/payer perspective was most common (74%).
- CEAs rarely incorporated non-health consequences or impacts beyond the healthcare sector.
- Societal perspective ICERs ($US22,710/QALY) were more favorable than healthcare sector ICERs ($US30,402/QALY).
Conclusions:
- Transparency and justification of chosen perspectives and costing methods are vital for researchers.
- Utilizing tools like the impact inventory and reporting disaggregate outcomes can enhance consistency and reduce confusion in CEAs.
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