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Factors Limiting Subgroup Analysis in Cost-Effectiveness Analysis and a Call for Transparency
Gemma E Shields1, Mark Wilberforce2, Paul Clarkson3
1Division of Population Health, Health Services Research, and Primary Care, Faculty of Biology, Medicine and Health, Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK. gemma.shields@manchester.ac.uk.
Pharmacoeconomics
|October 29, 2021
Summary
Using population averages in cost-effectiveness analysis can mask subgroup differences, leading to health inequalities. Transparent reporting of subgroup analyses is crucial for equitable resource allocation and improved population health outcomes.
Area of Science:
- Health Economics
- Public Health Policy
- Health Services Research
Background:
- Cost-effectiveness analysis (CEA) often relies on population averages.
- This approach may obscure significant variations across patient subgroups.
- Such limitations can lead to inefficient resource allocation and exacerbate health inequalities.
Purpose of the Study:
- To discuss factors limiting subgroup analysis in CEA.
- To propose enhanced and transparent reporting standards for subgroup analyses.
- To address the consequences of ignoring patient heterogeneity in CEA.
Main Methods:
- Discussion of challenges in CEA subgroup analysis.
- Identification of practical implementation barriers (e.g., data, statistical, ethical).
- Review of reporting standards and recommendations for future research.
Main Results:
- Subgroup analysis in CEA faces limitations including prespecification, identification, data, and ethical concerns.
- Failure to acknowledge patient heterogeneity can have substantial negative impacts.
- Incomplete subgroup analyses should be reported with clear rationales and limitations.
Conclusions:
- Acknowledging and reporting subgroup heterogeneity is vital for equitable health resource allocation.
- Improved transparency in reporting subgroup analyses is recommended.
- Addressing these challenges can improve the robustness and equity of future CEAs.
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